The document discusses the anatomy, pathophysiology, diagnosis, and treatment of sinusitis. It notes that sinuses are air-filled cavities in the skull that may serve purposes like lightening the skull and adding resonance to the voice. Sinusitis is defined as inflammation of the sinus lining caused by infection, allergy, or structural issues. It can be acute (less than 2 weeks), chronic (over 2 weeks), or recurrent. Diagnosis involves examination of the nasal cavity and sinuses, transillumination, and imaging tests. Treatment focuses on restoring sinus drainage with medications like antibiotics, decongestants, saline irrigation, and surgery if medical management fails. Complications can include orbital and intracranial infections
Dr. Ahmed M. Adawy, Professor Emeritus, Dep. Oral & Maxillofacial Surgery. Former Dean, Faculty of Dental Medicine
Al-Azhar University. There are four pairs of air sinuses making the boundaries of the nasal cavity. Maxillary sinus is the largest air cell. Anatomy and physiology of the maxillary sinus are given. Maxillary sinusitis is an inflammation of the sinus. Odontogenic causes represent nearly 30% of the etiology. Clinical and radiographic examinations are discussed together with treatment plan.
Oro-antral fistula is a rare complication of surgery at the posterior maxillary region. Several techniques for closure are presented. Additionally, information about sinus lift procedure is given.
Dr. Ahmed M. Adawy, Professor Emeritus, Dep. Oral & Maxillofacial Surgery. Former Dean, Faculty of Dental Medicine
Al-Azhar University. There are four pairs of air sinuses making the boundaries of the nasal cavity. Maxillary sinus is the largest air cell. Anatomy and physiology of the maxillary sinus are given. Maxillary sinusitis is an inflammation of the sinus. Odontogenic causes represent nearly 30% of the etiology. Clinical and radiographic examinations are discussed together with treatment plan.
Oro-antral fistula is a rare complication of surgery at the posterior maxillary region. Several techniques for closure are presented. Additionally, information about sinus lift procedure is given.
This slide is about oral hairy leukoplakia. it is basically a type of oral manifestation of some viral disease like HIV and HSV 4 (Epstein Barr virus )
This slide is about oral hairy leukoplakia. it is basically a type of oral manifestation of some viral disease like HIV and HSV 4 (Epstein Barr virus )
Rare presentation of left maxillary sinusitis: A Case Reportiosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
Sinusitis is defined as inflammation of the mucosal lining of the sinus passages. Frequent attacks of sinusitis for over three months, also known as chronic sinusitis, result in the thickening of the mucosal membranes and an excess production of nasal and sinus secretions. These secretions are usually thick and sticky and frequently predispose the sinuses to bacterial infection.
https://www.icliniq.com/articles/ent-health/sinusitis-causes-symptoms-and-treatment
Paranasal Sinuses (PNS) are air containing bony spaces around the nasal cavity. There are 4 pairs of paranasal sinuses(bilaterally) but maxillary sinus is considered most important to dentists due to proximity of maxillary sinus to orbit, alveolar ridge, diseases involving these structures may produce confusing symptoms. Hence precise information about surgical anatomy is essential to dental practitioners. the close anatomical relationship of the maxillary sinus and the roots of maxillary molars, premolars, and in some instances canines, can also lead to several endodontic complications. Clinicians must be particularly cautious when performing dental procedures involving the maxillary posterior teeth
Max sinus 2 final/certified fixed orthodontic courses by Indian dental academyIndian dental academy
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Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
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STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
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2. 07/27/14 Depertment of E.N.T 2
Para-nasal Sinuses
They are paired, air filled chambers in the skull.
Several theories propose that they serve to
lighten the skull, protect the brain during head
trauma and add resonance to the voice.
Varieties-
Four pairs of para-nasal
sinuses:
The Maxillary,
The Frontal,
The Ethmoid,
The Sphenoid,
3. 07/27/14 Depertment of E.N.T 3
Sinusitis-
Inflammation of the lining mucus membrane of a
sinus as a result of infection, allergy, structural or
mechanical abnormalities,
Multi- Sinusitis- If more than one sinus is infected,
Pan- Sinusitis- If all the sinuses are involved in the
inflammatory process,
Universal Law
“Where there is stasis, there is infection.”
Normally, secreted mucus is kept cleared off by the
action of gravity, of course aided by ciliary action
but when the ostium is obstructed, the mucus
collects in the sinus and gets infected, giving rise to
sinusitis,
4. 07/27/14 Depertment of E.N.T 4
Classification
Acute Sinusitis-
Infection of sinuses that lasts less than two weeks
and responds to antibiotic therapy,
Chronic Sinusitis-
Infection of sinuses that lasts longer than two
weeks, require longer courses of medical
therapy, and may require surgery.
Recurrent Sinusitis-
Either acute or chronic; it starts to resolve but
recurs because the treatment is either
inadequate or is stopped prematurely,
6. 07/27/14 Depertment of E.N.T 6
Pathogens
Acute Sinusitis- Aerobic bacteria like
streptococcus pneumoniae, haemophilus influenzae,
moraxella catarrhalis; Anaerobic bacteria (10%)-; Viral
(10-20%)- rhinovirus, influenza virus;
Chronic Sinusitis- Anaerobic bacteria like
peptococcus, streptococcus, either alone or in
combination with aerobic bacterium like
staphlococcus aureus;
Nosocomial Sinusitis- commonly due to
pseudomonas aeruginosa, klebsiella pneumoniae,
enterobactor species & proteus mirabilis,
Fungal Sinusitis- Aspergillosis, mucormycosis,
7. 07/27/14 Depertment of E.N.T 7
Patho- physiology
Located in the cheeks, the maxillary sinuses are the
largest. The natural ostium of each maxillary sinus is
situated high above the floor of the sinus, and the
evacuating effect of gravity is unfortunately missing.
No wonder, therefore that this sinus is the most
commonly infected. Infection of other sinuses is
frequently secondary to the infection of maxillary
sinus. Thus, treatment directed towards the maxillary
sinus often cures the secondarily infected sinuses.
For these reasons, the maxillary sinus is often called
the ‘master’ sinus.
Contd…
8. 07/27/14 Depertment of E.N.T 8
The mucus membranes of the nose and sinuses
normally produce 1 to 2 liters of mucus a day. If the
nasal passages become irritated by allergies, air
pollution, smoke or infection, more clear watery
mucus is produced to wash away irritants or
foreign substances. This profuse secretion is the
most common cause of postnasal drip. Bacterial
infections produce a thick, sticky mucus containing
pus, which is usually yellow or green.
This mucus blanket is
propelled backwards by the
metachronous movement of
cilia. Therefore lack of ciliary
movement will also result in
stasis and infection.
9. 07/27/14 Depertment of E.N.T 9
Aetiology
All cases of rhinitis by continuity of mucosa through
sinus ostia,
Acue infectious fevers, concerned with the
respiratory tract/ or through blood stream,
Trauma (accidental)- e.g. RTAs, gun shot injuries,
and trauma (operative)- e.g. SMR, polypectomy,
Severe deflected septum pressing on the lateral
wall,
Nasal polypi, adenoids, tonsillitis tend to cause stasis,
Infections in the pharynx, the larynx, the tracheo-
bronchial tree and the lungs,
Contd…
10. 07/27/14 Depertment of E.N.T 10
Root abscess in Teeth (bicuspid & tricuspid)/ dental
extraction leading to oro-antral fistula- 10% of all
cases are dental in origin,
Bathing and diving in infected water,
Poor state of health with lowered body resistance,
an imbalanced diet with excess of starches & little
proteins/ vitamins; dark, damp, overcrowded living
conditions, favour cross- infection,
Wet and cold weather,
Sedentary occupations & working conditions with
dusty, polluted atmosphere,
11. 07/27/14 Depertment of E.N.T 11
Pathology
Acute catarrhal stage- Hyperema and
swelling of sinus mucosa with exudation of some
thin mucoid discharge; under microscope,
blood vessels are seen dilated with slight
leucocytic infiltration, cilia present on lining
mucosa,
Acute suppurative stage- Mucosal swelling
increases, cilia may be shed off with gross
leucocytic infilteration- polymorphs and
eiosinophilia, retension of discharge in the sinus
cavity due to blocked ostia,
Contd…
12. 07/27/14 Depertment of E.N.T 12
Chronic suppurative stage- Gross hypertrophy
of sinus mucosa leading to polypoidal
excrescences, easily seen on x-ray examination;
mucosa may be shed off in places or may have
undergone stratified squamous metaplasia; in late
cases, erosion of the wall of the sinus in some
places and thickening in others; At some places,
there may be polypus or cyst formation in the
mucus membrane and in other places, sinus
mucosa may have undergone atrophy.
13. 07/27/14 Depertment of E.N.T 13
Symptoms
Local-
A sense of fullness or tension around
the affected sinus, aggravated on
stooping & coughing,
Pain in cheek below the eye and
upper teeth on affected side, may
refer to supra-orbital region,
Puffiness over the face, forehead or
the eyelids,
Nasal discharge- muco-purulent or
purulent, moderate in amount,
General-
Rise of temperature, rise of pulse rate,
and other symptoms of generalized
toxemia,
14. 07/27/14 Depertment of E.N.T 14
Examination
First of all, see pt. as such:
looks very toxic with raised
temperature & pulse, flushed
face, appear in agony,
On local exam.-
Ant. Rhinoscopy shows
congestion and swelling of
nasal mucosa, septum seen in
contact with swollen turbinals,
with thin or thick discharge,
Post. Rhinoscopy shows
generalized congestion and
discharge sticking to the
boundaries of post. nares &
walls of naso-pharynx,
Contd…
15. 07/27/14 Depertment of E.N.T 15
Palpation elicits tenderness over
the affected sinus. with
comparison to the opposite side,
provided it is healthy. Tapping over
the sinus is also helpful,
Hyperasthesia tested with wool or
pin prick gives additional
information,
Trans-illumination test- a small bulb
placed in pt.’s mouth in a dark
room lits the skull and sinuses. If
both sides illuminate equally, either
both sides are healthy or they are
equally diseased. If one side
illuminates less than the other, that
side may be at fault from
collection of pus, blood or growth
in the antrum. Test is not carried
out below the age of nine, and is
only 50% trustworthy,
Palpation of Max. sinus
Contd…
16. 07/27/14 Depertment of E.N.T 16
X-rays are trustworthy in 90% cases when taken in suitable
positions, False haziness of a sinus means thickened
mucosa, growth or blood in the sinus, thick normal bones
or swollen overlying tissues unless fluid level can be seen in
the suspected sinus; therefore, x-rays should be
considered in association with history & clinical
examination.
Lt. Max. SinusitisPansinusitis
17. 07/27/14 Depertment of E.N.T 17
Fluid level in the Lt. max.
sinus in a case of Acute
Max. Sinusistis.
Bil. Hazy Max. Sinuses
in a case of Chronic
Max. Sinusitis.
18. 07/27/14 Depertment of E.N.T 18
Laboratory workup
CBC with a differential white blood count
provides useful information regarding infection,
ESR monitors the course of infection,
Culturing of sinus discharge, ideally when the
patient is not being treated with antibiotics, is the
most important test.
19. 07/27/14 Depertment of E.N.T 19
Recent sinus investigations
Sinogram- Ultrasonic examination of a sinus to
differentiate fluid or mucosal thickening from a solid
growth,
Sinocopy- Physical examination of a sinus by a
fibroptic sinoscope, now performed in the physician’s
office; clarifies the diagnosis in patients who are not
responding adequately to medical treatment,
CT Scan- Imaging studies are indicated for refractory
or recurrent sinusitis; sinusitis with complications and
preparations for surgery to build a `road map` that
the surgeon follows during surgery,
MRI Scan- used to access soft tissue changes and to
evaluate the extent of sinus tumor.
20. 07/27/14 Depertment of E.N.T 20
Clinical correlation of radiological findings
is essential
21. 07/27/14 Depertment of E.N.T 21
Orbital Complications
Inflammatory oedema
Orbital cellulitis
Subperiosteal abscess
Orbital abscess
Cavernous sinus thrombosis
Intracranial Complications
Meningitis
Epidural abscess
Subdural abscess
Brain abscess
Misc.Complications
Osteomyelitis of the Skull
Osteomyelitis of superior Maxilla
Mucocele or pyocele
Complications
22. 07/27/14 Depertment of E.N.T 22
…Complications
Because of these serious consequences, physician
must learn to diagnose the disease and be ready to
treat it aggressively. Any sign of intra-orbital or
intracranial spread demands contrast enhanced CT
scan of the head in both axial and coronal planes.
Complications of sinusitis usually follow the acute
stage of the disease or occur during an acute
exacerbation of a chronic infection
23. 07/27/14 Depertment of E.N.T 23
Signs of Complications
Generalized persistent headache
Vomiting
Convulsions
Chills or high fever
Edema or increasing swelling of the forehead
or eyelids
Blurring of vision, diplopia, or persistent
retroocular pain
Signs of increased intracrial pressure
Personality changes or dulling of the
sensorium.
24. 07/27/14 Depertment of E.N.T 24
Treatment
Inflammatory sinus disease is first treated
conservatively with medication.
GOAL OF MEDICAL TREATMENT
“Re-establish patency of the sinus ostea &
restore normal mucociliary clearance”
CAUSE OF THE INFLAMMATION OR OBSTRUCTION
MUST BE TARGETTED FOR MEDICAL THERAPY TO BE
SUCCESSFUL
Allergy
Nasal polypi etc.
25. 07/27/14 Depertment of E.N.T 25
General
“Complete rest in bed, easily digestible nourishing diet,&
analgesia for the relief of pain is usually rewarding.”
Antibiotics:
Acute and chronic sinus infections should be treated with
antibiotic to eradicate causative bacteria.
Ideally antibiotic is chosen after a nasal swab for C/S or
sinus aspirate for C/S.
Generally treatment is started with broad spectrum
antibiotics, i.e. ampicillin or amoxicillin, given 14 days for
acute sinusitis or 3-4 weeks for chronic Sinusitis, they are
effective against the most likely pathogens; if ineffective, a
second generation cephalosporin may be used for 3-6
weeks.
Anti-histamines are effective in relieving the allergic
symptoms, use of topical or oral corticosteroids may help
reduce inflammation and secretions.
contd…
26. 07/27/14 Depertment of E.N.T 26
Allergic Desensitization- In patients with seasonal allergies,
desensitization (allergy shots) may help relieving chronic
symptoms,
Sinus drainage & irrigation- With clogged sinus ostia and
failed drainage system, nasal decongestant sprays to open
up sinus channels are more helpful than antihistamines and
corticosteroids & help restore normal drainage. Oral
decongestants reduce nasal and sinus mucosal congestion
and can be used over a long period of time. Saline nasal
douches are also helpful in restoring nasal mucociliary
function and in return improve sinus drainage. When
medical treatment fails, mechanical irrigation and
aspiration is undertaken.
Antifungal Chemotherapy- Is sometimes required
especially in cases of rhinocerebral mucormycosis or
aspergillosis with or without surgical removal of disease
depending on the extent of disease.