Acute and Chronic Sinusitis

1. Sinusitis
Dr.Kaminee Kumar Tripura
MBBS, DLO (BSMMU)
Assistant Professor,
President Abdul Hamid Medical College & Hospital, Kishoreganj.

2. ANA
TOMY

3. • Supreme
turbinate

4. • Basal
Lamella
• Uncinate
process
• Bulla
Ethmoidalis
• Hiatus
Semilunaris
• Infundibulum

5. Osteomeatal complex
• Drainage pathway for ant. group of sinuses
• Medially - middle turbinate
• Laterally - lamina papyracea
• Superiorly & Posteriorly- the basal lamella
1. Multiple bony structures - Middle turbinate, uncinate
process, Bulla ethmoidalis
2. Air spaces - Frontal recess, ethmoidal infundibulum,
middle meatus
3. Ostia of anterior ethmoidal, maxillary and frontal

6. Osteomeatal
Complex

7. 1. Sphenoethmoidal recess:
sphenoid sinus
2. Superior meatus: posterior
ethmoid sinuses
3. Middle meatus:
• Frontal sinus
• Maxillary sinus
• Anterior ethmoid sinuses
4. Inferior meatus : nasolacrimal
duct

9. Para Nasal Sinuses

10. Anterior
Group
• Maxillary Sinus
• Frontal Sinus
• Anterior
ethmoidal
Posterior
Group
• Posterior
Ethmoidal Sinus
• Sphenoid Sinus

11. • The Ethmoid and
Maxillary sinuses -
birth.
• The frontal sinus -
2nd year
• Sphenoid sinus - 3rd
year

13. Functions Of Paranasal Sinuses
• Air Conditioning
• Resonance to voice
• Thermal insulators
• Lighten skull bones

14. Maxillary Sinus ( Antrum Of Highmore)
• Largest
• Pyramidal
Base - lateral wall of nose
Apex – zygomatic process
• Capacity – 15ml
• Normal ostium – posterior
part of infundibulum

15. • Roof – floor
of orbit
• Anterior wall – facial surface of
maxilla
• Posterior wall – Infratemporal &
Pterygopalatine fossa
• Medial wall – middle & inferior
meatuses
• Floor – alveolar & palatine process
of maxilla
• 1cm below level of floor of nose

16. Frontal Sinus
• 2nd largest
• Rarely symmetrical……..Thin
bony septum
• Anterior wall – skin forehead
• Inferior wall – orbit
• Posterior wall – meninges,
frontal lobe
• Frontonasal duct
• Drains to – Frontal recess,
infundibulum

17. Frontonasal duct

18. Ethmoidal Sinuses
• Anterior group – middle
meatus
• Posterior group – superior
meatus
• Roof – anterior cranial fossa(
lateral to
cribriform plate)
• Lateral wall – orbit ( Lamina
Papyracea )

19. Sphenoid Sinus
• Rarely symmetrical……..Thin
bony septum
• Below sella tursica
• Ostium – upper
anterior wall -------
sphenoethmoidal
recess

20. Relations….
• Anterior part roof – olfactory tract, optic
chiasma, frontal lobe

23. Physiology Of Paranasal
Sinuses

24. Ventilation & Mucous Drainage
• Inspiration – negative pressure – emptied
• Expiration – positive pressure – filled
• Mucous from anterior
groups – lateral pharyngeal gutter
• Posterior groups – posterior pharyngeal wall

25.  It is the acute inflammationof sinus mucosa.
 Most commonly involved sinus is maxillarysinus(ethmoid»frontal
»sphenoidsinuses)
Multisinusitis
 SINUSITIS
Pansinusitis
Open type
 SINUSITIS
Closed type

26. BACTERIOLOGY:
Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis,
Streptococcus pyogenes, Satphylococcus aureus, Klebsiella pneumoniae .Anaerobic
infections are seen in sinusitis of dental origin.
A) EXCITING CAUSES :
 Nasalinfections:Viral rhinitis followed by bacterial invasion.
 Swimming and diving: infected water enters sinuses through ostia.
 Trauma: Compoundfractures or penetrating injuries.
 Dental infections.

27. B) PREDISPOSING CAUSES :
LOCAL:
 Obstruction to sinus ventilation and drainage ( DNS,hypertrophic
turbinates, polyp,edema of ostia, neoplasms, edema of ostia).
 Stasis of secretions in nasal cavity( Cystic fibrosis ,enlarged adenoids,
choanal atresia)
 Previous attacks of sinusitis.
GENERAL
 Environment: Cold and wet climate.
 Poor general health: Exanthematous fever (measles,chickenpox),nutritional
deficiencies, systemic disorders.

29. AETIOLOGY:
 Dental infections(periapical dental abscess, oroantral fistula).
 Viral rhinitis followed by bacterial invasion.
 Diving and swimming.
 Trauma (fractures and penetrating injuries).
Clinical features :
 Constitutional symptoms.
 Headache.
 Pain.
 Tenderness.
 Redness and edema of cheek.
 Nasal discharge.
 Postnasal discharge.

30. DIAGNOSIS:
 Xray: WATER’S VIEW.
 CT is preferred..
 ANTERIOR NASAL ENDOSCOPY
PUS SEEN IN MIDDLE MEA
TUS

31. CT CORONAL SECTION

32. TRANSILLUMINA
TION OF MAXILLARY SINUS
TRANSILLUMINATION TEST:
TRANSILLUMINOSCOPE

33. TREATMENT:
MEDICAL
 Antimicrobial drugs( ampicillin/amoxicillin/erythromycin)
 Nasal decongestant drops ( 0.1% oxy or xylometazoline).
 Steam inhalation.
 Analgesics.
 Hot fomentation.
SURGICAL
 Antral lavage
NASAL SPRA
YS

34. AETIOLOGY:
 Viral rhinitis followed by bacterial invasion.
 Diving and swimming.
 Trauma (fractures and penetrating injuries).
 Oedema of middle meatus 2⁰ to ipsilateral maxillary sinus infection.
CLINICAL FEATURES:
 Frontal headache.(OFFICE HEADACHE)
 Tenderness.
 Oedema of upper eyelid.
 Nasal discharge.

35. DIAGNOSIS:
 Xray: WATER”S VIEW/LATERAL VIEW.
 CT is preferred.
TREATMENT:
MEDICAL
 Antimicrobial drugs.
 Nasal decongestant drops.
 Steam inhalation.
 Analgesics.
 Hot fomentation.

36. SURGICAL
Trephination of frontal sinus.

37. AETIOLOGY:
 Associated with infection of other sinuses.
CLINICAL FEATURES:
 Pain.
 Oedema of lids.
 Nasal discharge(middle or superior meatus).
 Swelling of the middle turbinate.

38. DIAGNOSIS:
 Computed tomography.
TREATMENT:
 Medical treatment same as for acute maxillary sinusitis.
 In case of posterior orbit abscess ,drainage of ethmoid sinuses into nose
through external ethmoidectomy incision may be required.

39. AETIOLOGY:
 As a part of pansinusitis.
 Associated with infection of posterior ethmoid sinuses.
CLINICAL FEATURES:
 Headache.
 Postnasal discharge.
DIAGNOSIS:
 Xray/CT.
 TREATMENT:
 Medical treatment same as for acute maxillary sinusitis.

40.  It is the sinus infection lasting for months or years.
 Important cause is failure of acute infection to resolve.
 PATHOPYSIOLOGY:
Pollution,chemicals,infections.
LOSS OF CILIA
IMPAIRED
DRAINAGE
Polypi,DNS,
adenoids,
tumors,
allergy
INFECTION
Inadequate therapy of acute sinusitis
MUCOSAL
CHANGES
ALLERGY

41. PATHOLOGY:
 Destruction and healing of sinus mucosa.
 Hypertrophic sinusitis.
 Atrophic sinusitis.
 Submucosa infiltrated with lymphocytes and plasma cells.
CLINICAL FEATURES:
 Similar to acute sinusitis but of lesser severity.
 Purulent nasal discharge is the commonest complaint.
 Foul smelling discharge( anerobic infections).
 Local pain and tenderness are not marked.
 Nasal stuffiness and anosmia(in some patients).

42. DIAGNOSIS:
 Xray (mucosal thickening)
 Xray with contrast.
 CT
 Aspiration( pus is confirmatory).
TREATMENT
 Cause for obstruction of sinus drainage and ventilation to be found out.
 Work up on nasal allergy may be required..
 Culture and sensitivity ( selection of antibiotic).
 Conservative management(antibiotics, decongestants, antihistaminics)

43. SURGICAL TREATMENT:
 CHRONIC MAXILLARY SINUSITIS
 Antral puncture and irrigation.
 Intranasal antrostomy.
 Caldwell-lucoperation.
ANTRAL PUNCTURE

44. CHRONIC FRONTALSINUSITIS
 Intranasal drainage operations.
 Trephination of frontal sinus.
 External fronto-ethmoidectomy.
( Howarth or Lynch’s operation)
 Osteoplastic flap operation.
HOWARTH’S OR L
YNCH OPERA
TION

45. CHRONIC ETHMOIDSINUSITIS
 Intranasal ethmoidectomy.
 External ethmoidectomy.
CHRONIC SPHENOIDSINUSITIS
 Sphenoidotomy.
FESS HAS NOWREPLACEDCONVENTIONALSURGERIES.

46. TYPES
A- Local Mucocele/Pyocele
Mucous retention cyst
Osteomyelitis- frontal bone and maxila
B- Orbital Preseptal inflammatory oedema of lids
Subperiosteal abscess
Orbital cellulitis
Orbital abscess
Superior orbital fissure syndrome
Orbital apex syndrome
C- Intacranial Meningitis Extradural
abscess Subdural
abscess Brain
abscess
Cavernous sinus thrombosis
D- Descending
infections
1) Otitis media
2) Pharyngitis and tonsillitis: hypertrophy of lateral lymphoid
3) Persistent laryngitis and tracheobronchitis
E- Focal infections Sinusitis may act as focus of infection is conditions like:
Polyarthritis, tenosynovitis, fibrositis and certain skin diseases.