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COMPLICATIONS OF SINUSITIS
DR MANOHAR, RESIDENT
INHS ASVINI
• Sinusitis
• Definition of Complications of sinusitis
• Classification
• Clinical features
• Diagnosis
• Investigations
•...
Definition
A complication of rhino-sinusitis may be defined as
any adverse progression of chronic or acute bacterial
infec...
CLASSIFICATION
(A) Acute
(a) Local
Frontal-> Pott’s puffy tumor
Ethmoid-> Orbital cellulitis
Maxillary
Sphenoid->Cavernous...
(b) Distant
Brain abscess
Septicaemia
Toxic shock syndrome
(B) Chronic
Mucocoeles -> pyocoeles
Clinical classification
Orbital (60-75%) Intracranial (15-20%) Bony (5-10%) Chronic
1. Preseptal cellulitis
2. Orbital cel...
Orbital Complications
• Most commonly involved complication site:
 Proximity to ethmoid sinuses
 Orbital septum is the o...
 Impaired venous drainage from thrombophlebitis
 Progression within 2 days
• Children more susceptible
< 7 years – isola...
Chandler Classification
Periorbital cellulitis (Chandler class I)
• Most common and least severe
• 70 to 80% of cases
• The edema confined to peri...
Orbital cellulitis (Chandler class II)
• Periorbital swelling
• Edema (95%)
• Proptosis
• No abscess formation
Medical treatment
• Parenteral therapy
Surgical management is indicated if:
1. The patient fails to respond to IV therapy ...
2. Ocular motility/visual acuity deteriorates
3. Cranial neuropathies develop
4. The patient develops an abscess other tha...
Subperiosteal abscess (Chandler class III)
• Pus between the orbital periosteum and the bony
orbital wall
• Typically betw...
• Medial subperiosteal abscess: Endoscopic drainage
combined with an external approach
• Laterally seated subperiosteal ab...
Orbital abscess (Chandler class IV)
• Extraconal (between the periosteum and the
extraocular muscles)
• Intraconal (locate...
Cavernous sinus thrombosis, or CST (Chandler class V)
• Proptosis (often Bilateral)
• Chemosis
• Progressive opthalmoplegi...
(A) (B)
Treatment
• Mortality rate up to 30%
• Surgical drainage
• Intravenous antibiotics
 High-dose
 Cross blood-brain barrier...
PROGNOSIS
• If prompt treatment is carried out with adequate
monitoring of patients during treatment, the
prognosis for th...
Intracranial
• Pathogenesis: two major mechanisms
• Direct extension
• Retrograde thrombophlebitis via the valveless diplo...
Five types
 Meningitis
 Epidural abscess
 Subdural abscess
 Intra-cerebral abscess
 Cavernous sinus, venous sinus thr...
Clinical features
• Nausea and vomiting, neck stiffness, and altered
mental state.
• Increased ICT, meningeal irritation, ...
Meningitis
Epidural Abscess
• Frontal sinusitis
Treatment
 Antibiotics
 Drain sinuses and abscess
• Frontal sinus trephination
• Frontal sinus cranialization
• Stereota...
Subdural Abscess
• Third-most common intracranial complication, rapid
deterioration
• Mortality in 25-35%
• Residual neuro...
Treatment
• Medical therapy (< 1.5cm)
 Antibiotics
 Anticonvulsants
 Mannitol
 Steroids
• Surgical
 Drain sinuses and abscess
 Craniotomy or stereotactic burr hole
Intra-cerebral Abscess
• Clinical features
 Headache (70%)
 Mental status change (65%)
 Focal neurological deficit (65%...
Treatment
• Medical
 Antibiotics, Anticonvulsants
 Mannitol
 Steroids
• Surgical
• Bur hole drainage, craniotomy, or im...
Venous Sinus Thrombosis
• Sagittal sinus most common
• Retrograde thrombophlebitis from frontal
sinusitis
• Extremely ill
...
• Aggressive medical therapy
• Anticoagulation controversial
• Thrombus resolution by 6 weeks
• Increased intracranial pre...
Bony Complications
• Pott’s puffy tumor
• Frontal sinusitis with acute osteomyelitis
• Subperiosteal pus collection leads ...
• Clinical features
• Periorbital or frontal swelling
Surgical and medical therapy
• Drain abscess and remove infected bone
• Intravenous antibiotics for six weeks
• May oblite...
References
• Scott brown
• Rhinology (David W Kennedy)
• OCNA
THANK YOU
Complications of sinusitis
Complications of sinusitis
Complications of sinusitis
Complications of sinusitis
Complications of sinusitis
Complications of sinusitis
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Complications of sinusitis

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Complications of sinusitis

  1. 1. COMPLICATIONS OF SINUSITIS DR MANOHAR, RESIDENT INHS ASVINI
  2. 2. • Sinusitis • Definition of Complications of sinusitis • Classification • Clinical features • Diagnosis • Investigations • Treatment
  3. 3. Definition A complication of rhino-sinusitis may be defined as any adverse progression of chronic or acute bacterial infection beyond the paranasal sinuses, or compromise in function of any part of the body due to local or distant effects of the condition.
  4. 4. CLASSIFICATION (A) Acute (a) Local Frontal-> Pott’s puffy tumor Ethmoid-> Orbital cellulitis Maxillary Sphenoid->Cavernous sinus thrombosis
  5. 5. (b) Distant Brain abscess Septicaemia Toxic shock syndrome (B) Chronic Mucocoeles -> pyocoeles
  6. 6. Clinical classification Orbital (60-75%) Intracranial (15-20%) Bony (5-10%) Chronic 1. Preseptal cellulitis 2. Orbital cellulitis 3. Subperiosteal abscess 4. Orbital abscess 5. Cavernous sinus thrombosis 1. Meningitis 2. EpiduraI abscess 3. Subdural abscess 4. Intracerebral abscess 5. Cavernous or sagittal sinus thrombosis Osteomyelitis (Pott's puffy tumour) Mucocoele/pyocoele
  7. 7. Orbital Complications • Most commonly involved complication site:  Proximity to ethmoid sinuses  Orbital septum is the only soft-tissue barrier  Valveless superior and inferior ophthalmic veins • Continuum of inflammatory/infectious changes  Direct extension through lamina papyracea
  8. 8.  Impaired venous drainage from thrombophlebitis  Progression within 2 days • Children more susceptible < 7 years – isolated orbital (subperiosteal abscess) > 7 years – orbital and intracranial complications • Acute pansinusitis leads to 60 to 80% of orbital complications
  9. 9. Chandler Classification
  10. 10. Periorbital cellulitis (Chandler class I) • Most common and least severe • 70 to 80% of cases • The edema confined to periorbital eyelid by the orbital septum • Mild proptosis
  11. 11. Orbital cellulitis (Chandler class II) • Periorbital swelling • Edema (95%) • Proptosis • No abscess formation
  12. 12. Medical treatment • Parenteral therapy Surgical management is indicated if: 1. The patient fails to respond to IV therapy and/or deteriorates clinically despite appropriate antibiotic therapy
  13. 13. 2. Ocular motility/visual acuity deteriorates 3. Cranial neuropathies develop 4. The patient develops an abscess other than a small, medially located subperiosteal abscess
  14. 14. Subperiosteal abscess (Chandler class III) • Pus between the orbital periosteum and the bony orbital wall • Typically between the lamina papyracea and the medial periorbita
  15. 15. • Medial subperiosteal abscess: Endoscopic drainage combined with an external approach • Laterally seated subperiosteal abscess: Decompression and drainage of the orbit through an external approach
  16. 16. Orbital abscess (Chandler class IV) • Extraconal (between the periosteum and the extraocular muscles) • Intraconal (located centrally within the muscle cone)
  17. 17. Cavernous sinus thrombosis, or CST (Chandler class V) • Proptosis (often Bilateral) • Chemosis • Progressive opthalmoplegia • Complete loss of vision
  18. 18. (A) (B)
  19. 19. Treatment • Mortality rate up to 30% • Surgical drainage • Intravenous antibiotics  High-dose  Cross blood-brain barrier • Anticoagulant use is controversial  Prevent thrombus propagation  Risk intracranial or intra-orbital bleeding
  20. 20. PROGNOSIS • If prompt treatment is carried out with adequate monitoring of patients during treatment, the prognosis for the return of normal vision is excellent. • However, there is a small, but significant risk of diplopia following surgery
  21. 21. Intracranial • Pathogenesis: two major mechanisms • Direct extension • Retrograde thrombophlebitis via the valveless diploic veins
  22. 22. Five types  Meningitis  Epidural abscess  Subdural abscess  Intra-cerebral abscess  Cavernous sinus, venous sinus thrombosis
  23. 23. Clinical features • Nausea and vomiting, neck stiffness, and altered mental state. • Increased ICT, meningeal irritation, and focal neurologic deficits, including CN III, VI, and VII palsies
  24. 24. Meningitis
  25. 25. Epidural Abscess • Frontal sinusitis
  26. 26. Treatment  Antibiotics  Drain sinuses and abscess • Frontal sinus trephination • Frontal sinus cranialization • Stereotactic-guided drainage
  27. 27. Subdural Abscess • Third-most common intracranial complication, rapid deterioration • Mortality in 25-35% • Residual neurologic sequelae in 35-55%
  28. 28. Treatment • Medical therapy (< 1.5cm)  Antibiotics  Anticonvulsants  Mannitol  Steroids
  29. 29. • Surgical  Drain sinuses and abscess  Craniotomy or stereotactic burr hole
  30. 30. Intra-cerebral Abscess • Clinical features  Headache (70%)  Mental status change (65%)  Focal neurological deficit (65%)  Fever (50%)  Mortality 20-30%  Neurologic sequelae 60%
  31. 31. Treatment • Medical  Antibiotics, Anticonvulsants  Mannitol  Steroids • Surgical • Bur hole drainage, craniotomy, or image-guided aspiration
  32. 32. Venous Sinus Thrombosis • Sagittal sinus most common • Retrograde thrombophlebitis from frontal sinusitis • Extremely ill • Increased mortality
  33. 33. • Aggressive medical therapy • Anticoagulation controversial • Thrombus resolution by 6 weeks • Increased intracranial pressure outweighs bleeding risk Drain sinuses • External • Endoscopic
  34. 34. Bony Complications • Pott’s puffy tumor • Frontal sinusitis with acute osteomyelitis • Subperiosteal pus collection leads to “puffy” fluctuance
  35. 35. • Clinical features • Periorbital or frontal swelling
  36. 36. Surgical and medical therapy • Drain abscess and remove infected bone • Intravenous antibiotics for six weeks • May obliterate frontal sinus to prevent recurrence
  37. 37. References • Scott brown • Rhinology (David W Kennedy) • OCNA
  38. 38. THANK YOU

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