PARANASAL SINUSES Anatomy, Physiology and Diseases Maria Angelica M. Geronimo Group 5a

PARANASAL SINUSES Air-filled cavities that communicate with the nasal cavities

PARANASAL SINUSES Anatomy

NASAL CAVITY Anterior Ethmoid cells Frontal Sinus Maxillary Sinus Middle Meatus NASAL CAVITY Posterior Ethmoid cells Superior Meatus NASAL CAVITY

MAXILLARY SINUS Medial: nasal cavity Floor: close to the root of the second premolar and first molar teeth Posterior: Pterygopalatine fossa Traversed by the maxillary artery, branches of the CN V and ANS

ETHMOID AIR CELLS Labyrinthine system of small, pneumatized sinus cavities Posterior: close to CN II Lamina papyracea Orbital plate Forms the lateral bony wall that separates it from the orbit

SPHENOID SINUS Center of the skull above the nasopharynx Clivus - forms the posterior wall Superior: sella turcica + pituitary, and anterior and middle cranial fossae Lateral: cavernous sinus, ICA and CN II-VI Closely related to CN II

FRONTAL SINUS Floor: forms the medial portion of the orbital roof Anterior: anterior cranial fossa

PARANASAL SINUSES Physiology

Functions Humidification Vocal resonance Mucus production Increased olfactory area Absorbs shock to the head Regulation of intranasal pressure

PARANASAL SINUSES Diseases

Sinus Inflammation Acute Chronic

MAXILLARY SINUSITIS Predisposing factors Symptoms Signs Organism Mild URTI Nasal allergies Foreign bodies Deviated nasal septum Symptoms Fever, vague headache relieved by analgesics, malaise Fullness of the face, pain in the teeth esp. upon going up and down the stairs Dull, throbbing cheek pain Signs Tenderness to pressure and percussion Foul, mucopurulent secretions Decreased transillumination Water’s view- mucosal thickening and opacification of the maxillary sinuses Organism Streptococcus pneumoniae, H. Influenzae, anaerobes, Branhamella Catarrhalis Treatment Antibiotics, decogestants, analgesics

ETHMOID SINUSITIS Prevalence Symptoms Treatment Children: orbital cellulitis Adults: accompanies maxillary sinusitis Symptoms Pain and tenderness between the eyes and over the bridge of the nose Thick nasal secretions Nasal obstruction Treatment Antibiotics, nasal decongestants, analgesics, nasal sprays

FRONTAL SINUSITIS Prevalence Symptoms Treatment Associated with anterior ethmoditis Predominantly in adults Symptoms Pain is above the eyebrows usually in the AM, worse at midday, gradually lessens at the end of the day Forehead may be tender to touch and may have supra orbital swelling Treatment Antibiotics, decongestants, vasoconstrictor nasal sprays

SPHENOID SINUSITIS Prevalence Symptoms Treatment Associated with other sinusitis Not very common Symptoms Headache directed to the vertex of the skull Treatment Antibiotics, decongestants, vasoconstrictor nasal sprays

PARANASAL SINUSES Complications

Orbital Complications Orbital Cellulitis Abscess Subperiosteal abscess Orbital abscess Cavernous Sinus Thrombosis

MUCOCOELE Mucus containing cyst found in the sinuses Frequently seen in the maxillary sinuses (mucus retention cysts) Ethmoids or frontal sinuses: swelling in the forehead Sphenoids sinus: diplopia or impaired vision

PYOCOELE Similar to a mucocoele but contains pus Treatment: surgical removal and re-establishment of a good drainage

ACUTE MENINGITIS Infections may spread through venous channels or directly from neighboring sinuses such as posterior wall of the frontal sinus Fever, chills, nausea, vomiting, signs of meningeal irritation

DURAL ABSCESS Collection of pus between dura and internal table of the skull usually seen in frontal sinusitis Intractable headache, spiking fever, may have signs of meningeal irritation Increased ICP

BRAIN ABSCESS Occurs through directly extending thrombophlebitis Brain may be contaminated at the peak of a severe suppurative sinusitis Chills and fever, lack of appetite, weight loss, nausea and vomiting Treatment: Massive IV antibiotics, surgical drainage

OSTEOMYELITIS Commonly seen in frontal sinusitis Erosion of the frontal bone Localized forehead pain, fever, chills, swelling over brow area Radiographs: “moth-eaten” appearance of the margins of the sinuses