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Acute Sinusitis
- 1. ACUTE SINUSITI S -Anira Iqbal Batch 2011
- 3. EMBRYOLOGY • Beginto develop in 3rd fetal month • As outpouchings of mucous membranes of Superior and Middle Meatus • 2 processes – Primary pneumatization Secondary pneumatization • Primary – Differential growth Diverticular pouches/recesses expansion of wall itself to elaborate air space • Secondary – Expansion outside wall occupies space within craniofacial bones
- 4. Sinus Development Primary pneumatizn Secondary pneumatizn Remarks Maxillary From middle meatus invaginating into maxilla 10 weeks iu 5 months IU At birth-Clinically significant(4-8ml), Radio. Identifiable Reaches final size by 15 y Sphenoidal Recess b/w conchae of sphenoidal bone and sphenoidal body 4th month IU 6-7 y/o Absent at birth 7 y/o- reaches sella turcica 15 y – fully dev Varied degrees of pneumatization in adults Ethmoidal From Sup and Mid meatus to nasal capsule 4th month IU 2 y Can be identified at birth. Fully dev by 20y Frontal Frontal recess of middle meatus 4th month IU 6 mo V.Small at birth. Slow pneumatization Fully dev by 20y.
- 6. OSTEOMEATAL COMPLEX •Common channel that links frontal sinus, ant. and middle ethmoid sinus, and max sinus to middle meatus allows air flow and mucociliary drainage needs to be patent for drainage of secretions in sinusitis
- 9. ACUTE SINUSITIS •Acute (<4 wks) inflammation of sinus mucosa • Max.>Ethmoid>Frontal>Sphenoid • >1 sinus involved mostly – Multisinusitis • All the sinuses of 1 side – Pansinusitis unilateral • All the sinuses of both sides – Pansinusitis bilateral Can be of 2 types : 1. Open – Exudate escapes from sinus through natural ostia 2. Closed – Exudate cannot escape - more severe – greater risk of complications
- 10. ETIOLOGY EXCITING CAUSES 1. Nasal infections - Nasal mucosa Sinus mucosa MCC – Viral > Bacterial>>Fungal 2. Swimming/Diving – Infected water Ostia of sinuses - Chlorine Chemical inflammation 3. Trauma – Compound # or penetrating injuries infection 4. Dental infection – Molar/Premolar infection/extraction Max. sinus
- 11. PREDISPOSING CAUSES Local General LOCAL 1. Obstruction to sinus ventilation and drainage • Nasal packing • DNS • Hypertrophic turbinates • Allergy – oedema of sinus ostia • Nasal polypi • Benign/Malignant neoplasm 2. Stasis of secretions in nasal cavity • Cystic fibrosis – high viscosity of secretions • Enlarged adenoids - obstruction • Choanal atresia - obstruction
- 12. GENERAL 1. Environment– cold, wet - atm. pollution, smoke, dust, overcrowding 2. Poor general health – recurrent attacks of exanth. Fevers - nutritional deficiencies - Systemic disorders (Diabetes) - Immunodeficient BACTERIOLOGY • Streptococcus pneumoniae • Hemophilus influenzae • Moraxella catarrhalis • Streptococcus pyogenes • Staphylococcus aureus • Klebsiella pneumoniae • Anaerobic org. – Dental infections
- 13. PATHOLOGY Infection Acute Inflammation of sinus mucosa Hyperemia Exudation (serous mucopurulent/purulent) Outpouring of PMNs Increased activity of serous and mucus glands severe infection destruction of mucosal lining If failure of ostium to drain Empyema If destruction of bony walls complications • Mild/Non suppurative – less virulent, good immunity, drainage • Severe/Suppurative
- 14. ACUTE MAXILLARY SINUSITIS • ‘Antrum of Highmore’ • Largest • MC Sinus infected – drainage pattern • Pyramidal • Base – Lat. Wall of nose • Apex – Zygomatic process of maxilla • *Floor* - Rel. to molars and premolars extraction oroantral fistula
- 16. ETIOLOGY 1. MCC– Viral rhinitis 2. 2nd MCC – Bacterial invasion 3. Diving/swimming 4. *Dental infections* - Periapical dental abscess Tooth extraction 5. Trauma – Compound # Penetrating injuries Gunshot wounds
- 17. CLINICAL FEATURES 1.Due to toxemia – Fever Body ache Malaise 2. Headache – Forehead ( ~ Frontal) 3. Pain – Over upper jaw/referred to gums/teeth/ipsilateral supraorbital region (~frontal) - aggravated by stooping/coughing/chewing - worse if head upright, relieved if supine 4. Tenderness 5. Redness and oedema of cheek – children – thinner bone 6. Nasal discharge – Ant. Rhinoscopy/nasal endoscopy pus/mucopus in MM red swollen mucosa 7. Postnasal discharge – Post. Rhinoscopy/Nasal endoscopy Pus on upper soft palate
- 19. DIAGNOSIS • Transilluminationtest - Affected sinus Opaque
- 20. • X-rays –Water’s view (Occipito-mental view) – Air fluid level or opacification
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- 24. COMPLICATIONS 1. Subacute/Chronicsinusitis 2. Frontal sinusitis – Oedema obstruction of OMC obstruction of frontal sinus drainage pathway 3. Osteitis/Osteomyelitis of maxilla 4. Orbital cellulitis/abscess – Spread of infection a. direct – roof of maxillary sinus b. indirect – ethmoid sinus
- 25. ACUTE FRONTAL SINUSITIS•B/w inner & outer table of frontal bone, above & deep to supraorbital margin • Thin bony septum b/w the 2 asymmetric sinuses • Drainage ostium frontal recess (hourglass structure) infundibulum Middle meatus • Gravity heals faster
- 27. ETIOLOGY 1. Viralrhinitis 2. Bacterial invasions 3. Diving/Swimming 4. Trauma 5. Ipsilateral Maxillary/Ethmoid sinusitis
- 28. CLINICAL FEATURES 1.Frontal headache – Medial brow area ‘Office Headache’ – Comes up on waking Gradually increases Peak at mid-day Subsides 2. Tenderness – Tapping - Pressure upwards on floor of frontal sinus 3. Oedema of upper eyelid 4. Nasal discharge – Nasal endoscopy – vertical streak of mucopus high up in anterior part of middle meatus
- 29. DIAGNOSIS • X-ray – Water’s view
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- 31. COMPLICATIONS 1. Orbitalcellulitis 2. Osteomyelitis of frontal bone and fistula formation 3. Meningitis 4. Extradural abscess 5. Frontal lobe abscess 6. Chronic frontal sinusitis
- 32. ACUTE ETHMOID SINUSITIS • 3 to 18 in no. • B/w U 1/3 Lateral nasal wall & medial wall of orbit • V. low capacity • Ant. Group MM • Post. Group SM
- 34. ETIOLOGY • Infectionof other sinuses Clinical Features 1. Pain – bridge of nose – medial and deep to eye - aggravated by movements of eyeball - ‘Spectacle tenderness’ 2. Oedema of lids 3. Inc lacrimation 4. Nasal discharge – Ant group pus in MM Post group pus in SM spreads over post pharyngeal wall
- 35. COMPLICATIONS 1. Orbitalcellulitis and abscess 2. Optic Nerve Visual deterioration blindness 3. Cavernous sinus thrombosis 4. Extradural abscess 5. Meningitis 6. Brain abscess
- 36. • X-ray –Caldwell’s view (Occipito-frontal view)
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- 39. ACUTE SPHENOID SINUSITIS • Ostium high up in ant wall Sphenoethmoidal recess SM
- 40. ETIOLOGY • Isolatedinvolvement – rare • + Pansinusitis/Post. Ethmoidal sinusitis Clinical Features 1. Headache occiput/vertex - maybe referred to mastoid 2. Postnasal discharge – Posterior rhinoscopy pus on roof and post. Wall of NP
- 41. • X-ray –Lateral view • CT Scan
- 42.