1、鼻窦炎英文版鼻窦炎英文版lAnterior sinus :maxillary sinus maxillary sinus frontal sinus frontal sinus anterior ethmoidal sinusethmoidal sinusThey all open in the middle meatus.They all open in the middle meatus.lPosterior sinus:posterior ethmoidal sinus:open in ethmoidal sinus:open in the superior meatusthe supe
2、rior meatus sphenoid sinus:open in sphenoid sinus:open in sphenoethmoidal recesssphenoethmoidal recess overviewlSinusitis has been defined Sinusitis has been defined as an inflammation of the as an inflammation of the mucous membrane of the mucous membrane of the sinuses.sinuses.ltwo types-acute sin
3、usitis two types-acute sinusitis and chronic sinusitis.and chronic sinusitis.lAcute inflammation of sinus mucosa lThis commonly follows a cold.lThe sinus most commonly involved is the maxillary followed in turn by ethmoid,frontal and sphenoid.lMultisinusitis:lPansinusitis:lAetiology of sinusitis in
4、generallNasal infectionlSwimming and divinglTraumalDental infectionlPredisposing causeslObstruction to sinus ventilation and drainage1、nasal packing2、deviated septum3、hypertrophic turbinates4、nasal polypi5、oedema of sinus ostia due to allergy or vasomotor rhinitis 6、benign or malignant neoplasmlEnvi
5、ronment:atmospheric pollution,smoke,dustlPoor general health nutritional deficiencies systemic disorders(diabets,immune deficiency syndromes)lViral infection-bacterial invasionlpneumococci,streptococci,H.influenzaelAnaerobic organisms and mixed infections lAcute inflammation of sinus mucosa causes h
6、yperaemia,exudation of fluid,outpouring of polymorphonuclear cells and increased activity of serous and mucous glands.lDepending on the virulence of organisms,defences of the host and capability of the sinus ostium to drain the exudates,the disease may be mild(none-suppurative)or severe(suppurative)
7、lInitially,the exudate is serous;later it may become mucopurulent or purulent.lSevere infections cause destruction of mucosal lining.lFailure of ostium to drain results in empyema of the sinus and destruction of its bony walls leading to complications.Acute maxillary sinusitislMost commonly,it is vi
8、ral rhinitis which spreads to involve the sinus mucosa.This is followed by bacterial invasion.lDiving and swimming in contaminated water.lDental infections are important source of maxillary sinusitis.lTrauma lClinical features depend on severity of inflammatory process and efficiency of ostium to dr
9、ain the exudates.lClosed ostium sinusitis is of greater severity and leads more often to complications.lConstitutional symptoms consist of fever,general malaise and body ache.They are the result of toxaemia.lHeadache lPainlTendernesslRedness and oedema of cheek.lNasal discharge lPost nasal discharge
10、X-rays or CT scan:an opacity or a fluid level in the involved sinus.Antimicrobial drugslAmpicillin or amoxicillinlErythromycin or doxycycline or cotrimoxazolel-lactamase-producing strains of influenzae may necessitate the use of amoxicillin/clavulanic acid lsparfloxacinNasal decongestant dropsl1%eph
11、edrine steroidslAs nasal sprayslAvoid long-term systemic steroidsSteam inhalationlSteam alone provides symptomatic relief and encourage sinus drainage.lInhalation should be given 15 to 20 minutes after decongestion for better penetration.AnalgesicslParacetamol Hot fomentationlLocal heat to the affec
12、ted sinus is often soothing and helps in the resolution of inflammation.lAntral puncture and irrigationMost cases of acute maxillary sinusitis respond to medical treatment.Antral puncture and irrigation is rarely necessary.It is done only when medical treatment has failed and only under cover of ant
13、ibiotics.lChronic sinusitislOsteomyelitis of the maxillalOrbital cellulitis or abscesslAcute frontal sinusitisUsually follows viral infections of upper respiratory tract followed later by bacterial invasion.Entry of water into the sinus during diving or swimming.External trauma to the sinus.Oedema o
14、f middle meatus,secondary to associated maxillary or ethmoid sinus infection.lFrontal headachelTendernesslOedema of upper eyelid with suffused conjunctiva and photophobia.lNasal dischargelThis is same as for acute maxillary sinusitis:antimicrobials,decongestion,analgesics,steroid.lPlacing a pledget
15、of cotton soaked in a vasoconstrictor in the middle meatus,once or twice daily,helps to relieve ostial oedema and promotes sinus drainage and ventilation.lIf patient shows response to medical treatment and pain is relieved,treatment is continued for full 10 days to 2 weeks.lTrephination of frontal s
16、inus.If there is persistence of pain or pyrexia in spite of medical treatment for 48 hours,or if the lid swelling is increasing,frontal sinus is drained externally.lOrbital cellulitislOsteomyelitis of frontal bone lMeningitis,extradural abscess or frontal lobe abscess.lChronic frontal sinusitis.lAcu
17、te ethmoid sinusitislAcute ethmoiditis is often associated with infection of other sinuses.Ethmoid sinuses are more often involved in infants and young children.lPain lOedema of lidslNasal dischargelSwelling of the middle turbinatelMedical treatment is the same as for acute maxillary sinusitis.lVisu
18、al deterioration and exophthalmos indicate abscess in the posterior orbit and may require drainage of the ethmoid sinuses into the nose.lOrbital cellulitis and abscesslVisual deterioration and blindness due to involvement of optic nerve.lCavernous sinus thrombosis.lExtradural abscess,meningitis or b
19、rain abscess.lAcute sphenoid sinusitislIsolated involvement of sphenoid sinus is rare.It is often a part of pansinusitis or is associated with infection of posterior ethmoid sinuses.lHeadache:occiput or vertexlPostnasal dischargel neoplasms of the sphenoid sinus may clinically simulate features of a
20、cute infection of sphenoid sinus and should always be excluded in any case of isolated sphenoid sinus involvement.lChronic sinusitislSinus infection lasting for months or years is called chronic sinusitis.Most important cause of chronic sinusitis is failure of acute infection to resolve.lPersistence
21、 of infection causes mucosal changes,such as loss of cilia,oedema and polyp formation,thus continuing the vicious cycle.lIn chronic infections,process of destruction and attempts at healing proceed simultaneously.lSinus mucosa becomes thick and polypoidal or undergoes atrophy.lMixed aerobic and anae
22、robic organism are often presentlClinical features are often vague and similar to those of acute sinusitis but of lesser severity.lPurulent nasal discharge is commonest complaint.lFoul-smelling discharge suggests anaerobic infection.lLocal pain and headache are often not marked.lSome patients compla
23、in of nasal stuffiness and anosmia.lX-ray or CT scan:mucosal thickening or opacitylAspiration and irrigation:finding of pus in the sinus is confirmatory.lIt is essential to search for underlying aetiological factors which obstruct sinus drainage and ventilation.lA workup for nasal allergy may be req
24、uired.lCulture and sensitivity of sinus discharge helps in the proper selected of an antibiotic.lInitial treatment of chronic sinusitis is conservative,including antibiotics,decongestants,antihistaminics and steroids.lSome form of surgery is required either to provide free drainage and ventilation o
25、r radical surgery to remove all irreversible diseases.lRecently,endoscopic sinus surgery is replacing radical operations on the sinuses and provides good drainage and ventilation.It also avoids external incisions.Chronic maxillary sinusitisChroic frontal sinusitislCorrection of deviated septum lRemo
26、ve of a polyplRemove of anterior portion of middle turbinate lIntranasal ethmoidectomylThe ethmoid air cells and diseased tissue is removed between middle turbinate and the medial wall of orbit by the intranasal route.lAcess to the sphenoid sinus can be obtained by removal of its anterior wall.lostiomeatal complex,OMCuncinectomyOpen anterior ethmoid sinusEnlarge maxillary ostiumOpen posterior ethmoid sinusOpen sphenoid sinusOpen frontal siunsquestion
