Nasal Sinusitis By: Munirah AlRubaian Meriem Souissi Suha Mokiyad

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Presentation transcript:

Nasal Sinusitis By: Munirah AlRubaian Meriem Souissi Suha Mokiyad Loloa aldughiman Alaa Alenazi

Acute Sinusitis Definition: Acute inflammation of sinus mucosa is called acute sinusitis. The sinus most commonly involved is the maxillary followed in turn by ethmoid, frontal and sphenoid

AETIOLOGY OF SINUSITIS IN GENERAL: A. EXCITING CAUSES 1- Nasal infections. 2- Swimming and diving. 3- Trauma. Compound fractures or penetrating injuries of sinus . 4- Dental infections.

B. PREDISPOSING CAUSES: LOCAL 1. Obstruction to sinus ventilation and drainage. Normally, sinuses are well-ventilated. They also secrete small amount of mucus. They are: A- Nasal packing B- Deviated septum C- Oedema of sinus ostia due to allergy D- Nasal polyp E- Hypertrophic turbinates

2. Stasis of secretions in the nasal cavity. (Normal secretions of sinus) 3. Previous attacks of sinusitis. ( Local defences of sinus) mucosa are already damaged. GENERAL Environment . Poor general health .

A - ACUTE MAXILLARY SINUSITIS: AETIOLOGY: 1- Most commonly, it is viral rhinitis which spreads to involve the sinus mucosa. This is followed by bacterial invasion EX:,,Moraxella catarrhalis ,Streptococcus pyogen , Staphylococcus aureus , Klebsiella pneumonia ,Haemophilus influenza ,Streptococcus pneumonia

2-Diving and swimming in contaminated water. 3- Dental infections are important source of maxillary sinusitis. 4- Trauma to the sinus such as compound fracture

CLINICAL FEATURES 1- Constitutional symptoms. It consist of fever, general malaise 2- Headache 3- Pain. 4- Tenderness. 5- Redness and oedema of cheek. Commonly seen in children. 6- Nasal discharge

DIAGNOSIS: Transillumination test. Affected sinus will be found opaque. X-rays. Computed tomography (CT) scan

TREATMENT: MEDICAL: 1- Antimicrobial drugs. 2- Nasal decongestant drops 3- Steam inhalation. 4- Analgesics. 5- Hot fomentation. SURGICAL: Antral lavage.

COMPLICATIONS: 1- Acute maxillary sinusitis may change to subacute or chronic sinusitis. 2- Frontal sinusitis. 3- Osteitis or osteomyelitis of the maxilla. 4- Orbital cellulitis or abscess

ACUTE FRONTAL SINUSITIS AETIOLOGY 1 .viral infections of upper respiratory tract followed later by bacterial invasion. 2. Entry of water into the sinus during diving or swimming. 3. External trauma to the sinus . 4. Oedema of middle meatus .

CLINICAL FEATURES: 1. Frontal headache .(office headache) 2. Tenderness. 3.Oedema of upper eyelid with suffused conjunctiva and photophobia 4. Nasal discharge. TREATMENT : Medical treatment is the same as for acute maxillary sinusitis.

COMPLICATIONS 1. Orbital cellulitis. 2. Osteomyelitis of frontal bone and fistula formation. 3. Meningitis, extradural abscess or frontal lobe abscess. 4. Chronic frontal sinusitis,

Acute ethmoid sinusitis AETIOLOGY: Acute ethmoiditis is often associated with infection of other sinuses. Ethmoid sinuses are more often involved in infants and young children. CLINICAL FEATURES: 1. Pain, It is localized over the bridge of the nose, medial and deep to the eye . It is aggravated by movements of the eye ball. 2. Oedema of lids. Both eyelids become puffy and swollen 3. Nasal discharge.

TREATMENT: 1- Medical treatment is the same as for acute maxillary sinusitis. 2- visual deteriorahion and exophathalmos indicate abscess in the posterior orbit and may require drainage of the ethmoid sinuses into the nose through an external ethmoidectomy incision.

COMPLICATIONS: 1. Orbital cellulitis and abscess. 2. Visual deterioration and blindness due to involvement of optic nerve. 3. Cavernous sinus thrombosis. 4. Extradural abscess, meningitis or brain abscess.

ACUTE SPHENOID SINUSITIS AETIOLOGY Isolated involvement of sphenoid sinus is rare. It is often a part of pansinusitis or is associated with infection of posterior ethmoid sinuses. CLINICAL FEATURES: 1. Headache. 2. Postnasal discharge

DIFFERENTIAL DIAGNOSIS 1-X-rays . Opacity or fluid level may be seen in the sphenoid sinus. 2- Lateral view of the sphenoid sinus is taken in supine or prone position . 3- CT scan is more useful. DIFFERENTIAL DIAGNOSIS Mucocele of the sphenoid sinus or its neoplasms .

Treatment Treatment is the same as for acute infection of other sinuses

Chronic Sinusitis Definition: Sinus infection that last for months or years is called chronic sinusitis. Most important cause of chronic sinusitis is failure of acute infection to resolve. Bacteriology Mixed aerobic and anaerobic organisms are often present.

The Symptoms : 1- purulent and nasal discharge is the commonest 2- foul-smelling discharge 3- Local pain and headache And some patient complain of nasal stuffiness and insomnia

How to Diagnose it? X-ray – may show mucosal thickening and opacity Or X-rays with contrast material injection  may show soft tissue changes in the sinus mucosa. Computed tomography (CT) – Aspiration and irrigation  finding of pus in the sinus is confirmatory. useful in ethmoid and sphenoid sinus infections

Treatment the initial treatment is Conservative , including antibiotic , decongestants , antihistamine and sinus irrigation It is important to search for the underlying cause which obstruct sinus drainage and ventilation The culture and sensitivity of sinus discharge – helps for the proper antibiotic

CHRONIC SINUSITIS: CHRONIC MAXILLARY SINUSITIS 1. Antral puncture and irrigation 2. Intranasal antrostomy. 3. Caldwell–Luc operation. CHRONIC FRONTAL SINUSITIS 1. Intranasal drainage operations. 2.Trephination of frontal sinus 3. External frontoethmoidectomy 4. Osteoplastic flap operation

CHRONIC ETHMOID SINUSITIS 1. Intranasal ethmoidectomy. 2. External ethmoidectomy.

1. Fungal ball. Maxillary sinus is the most commonly involved followed by sphenoid, ethmoid and the frontal in that order.  Not invasive. Treatment: is surgical removal of the fungal ball .

2 - Allergic fungal sinusitis. It is an allergic reaction to the causative  Not invasive. 3 - Chronic invasive sinusitis. surgical removal of the involved mucosa, bone and soft tissues followed by antifungal therapy with i.v. amphotericin B. Invasive 4 - Fulminant fungal sinusitis. It is an acute presentation and is mostly seen in immunocompromised or diabetic individuals.

Complication: 1- Local complication Mucocele of paranasal sinuses mucous retention cysts osteomyelitis - osteomyelitis of the maxilla - osteomyelitis of the frontal bone

2- Orbital complication Inflammatory oedema of the lids Subperiosteal abscess Orbital cellulitis Orbital abscess Superior orbital fissure syndrome Orbital apex syndrome

3- intracranial complication Meningitis and encephalitis Extradural abscess Subdural abscess Brain abscess Cavernous sinus thrombosis 4- descending infection 5- Focal infection

THANK YOU ANY QUESTIONS ?

REFERENCES