DETAILS OF SINUSES & ITS DISEASES....LECTURE FOR BAMS FINAL YR & MS SHALAKYATANTRA...

1. SINUSITIS
Presented by-
DR.VARSHA DHAGE, M.S. Shalakya-ENT
Ass. Professor, Dept. Of Shalakyatantra
SNKDCT’s Nallasopara Ayurved Medical
College,dist.Palghar

3. PNS
 The spaces in certain skull bones which are
filled up with air, lined by pseudostratified
ciliated columner epithelium and are related
to the nose by their opening in the nasal
cavity , are called Paranasal sinuses.

4. Sr.n
o.
Name of sinus Site of sinus capacity shape drainage
1 Maxillary sinus Occupies
maxillary bone
15cc pyramidal In middle
meatus
2. Frontal Sinus Frontal Bone 7cc pyramidal In middle
meatus
3. Ant.ethmoidal
sinus
Ant.part of
lateral mass of
ethmoid bone
variable Ethmoidal
sinuses
look like
wings of s
butterfly
In middle
meatus
4, post.ethmoidal
sinus
Posteior part of
lateral mass of
ethmoid bone
variable In
sup.meatus
5. Sphenoidal sinus Body of
sphenoid bone
7cc spherical In
sup.meatus

5. TYPES OF PNS
 Four pairs of paranasal sinuses –
 Frontal-above eyes in forehead bone
 Maxillary-in cheekbones, under eye
 Ethmoid-between eyes and nose
 Sphenoid-in center of skull, behind nose and
eyes

6. FUNCTION OF PNS
 Decreasing the relative weight of the skull
 Increasing the resonance of the voice
 Providing a buffer against facial trauma
 Insulating sensitive structures from rapid
temperature fluctuations in the nose
 Humidifying and heating inspired air

7. PATHOPHYSIOLOGY
 Usually follows rhinitis, which may be viral or
allergic.
 May also result from abrupt pressure changes
(air planes, diving) or dental extractions or
infections.
 Inflammation and edema of mucous
membranes lining the sinuses cause
obstruction.
 This provides for an opportunistic bacterial
invasion.

8.  With inflammation, the mucosal lining of the
sinuses produce mucoid drainage. Bacteria
invade and pus accumulates inside the sinus
cavities.
 Postnasal drainage causes obstruction of nasal
passages and an inflamed throat.
 If the sinus orifices are blocked by swollen
mucosal lining, the pus cannot enter the nose
and builds up pressure inside the sinus cavities.

9. PREDISPOSING FACTORS
• Allergies, nasal deformities, cystic fibrosis,
nasal polyps, and HIV infection.
• Cold weather
• High pollen counts
• Smoking in the home
• Reinfection from siblings

10.  Acute Sinusitis – respiratory symptoms last
longer than 10 days but less than 30 days.
 Sub acute sinusitis – respiratory symptoms
persist longer than 30 days without
improvement.
 Chronic sinusitis – respiratory symptoms last
longer than 120 days.

11. ETIOLOGY OF SINUSITIS
 70% of bacterial sinusitis is caused by:
• Streptococcus pneumoniae
• Haemophilus influenzae
• Moraxella catarrhalis
 Other causative organisms are:
• Staphylococcus aureus
• Streptococcus pyogenes,
• Gram-negative bacilli
• Respiratory viruses

12. COMPLICATIONS OF SINUSITIS
 Intra-orbital
 Orbital cellulitis
 Orbital abscess
 Cutaneous fistula
 Mucocele
 Intra-cranial
 Extra-dural abcess
 Sub-dural abscess
 Meningitis
 Encephalitis
 Brain abscess
 Otitic hydrocephalus

13. DIFFERENTIAL DIAGNOSES
• Allergic rhinitis
• Non-allergic rhinitis
• Infectious rhinitis
• Drug-induced rhinitis
• Nasal polyps
• Dental abscess
• Carcinoma of sinus
• Cluster headache
• Structural defects (septum deviation)
• Nasal foreign body

14. EXAMINATIONN OF SINUSES
 Transillumination test-in a dark room. A low
voltage small lamp with long and narrow handle,
is kept in the mouth the lips closed.a cherry red
glow appears on both sides of faces and
pupils.absence of glow indicates presence of
pus or mucosal thickening.
 Posture test-
In standing postion-if pus appears in midle
meatus-frontal sinusitis
If pus appears after the head is bent forward –
maxillary sinus

15. RADIOLOGICAL EXAMINATION
Standard views For visualisation of
1. Occipitomental(water’s
view)
Maxillary sinus
2. Fronto-occipital Frontal & ethmoidal sinus
3. Lateral view Frontal & sphenoidal sinus
4. Submento-vertical Sphenoidal sinus
5. lt,.oblique & rt. oblique Ethmoid sinus

16. SINUSITIS
 Inflammation of mucosal lining of the para
nasal sinuses is called sinusitis.
 If all sinuses are affected ,then it is called
Pan-Sinusitis.
 Commenest type –maxillary sinusitis

17. ACUTE MAXILLARY SINUSITIS
 Predisposing factor-
 Spread of nasal infection
 Trauma
 Spread of dental infection-premolar and
molar teeth
 Causative organism- viral.bacterial

18. CLINICAL FEATURES
 Pain in maxillary region radiateing to eyes
 Tenderness over the canine fossa
 Headache,fever,malaise
 Nasal discharge-initially mucoid,later on
purulent due to secondary infection.may b
blood stained.
 Foul smelling dicharge indicates dental infection
 Dicharge may be seen trickling down from the
middle meatus.

19. DIAGNOSIS
 X ray PNS water’s view-hazziness or
complete opacity
 CT scan

20. TREATMENT
 ANTIBIOTICS
 NASAL DECONGESTANTS
 STEAM INHALATION
 ANALGESICS
 ANTIHISTAMINES
 SURGICAL TREATMENT-ANTRAL
PINCTURE/INTRANASAL ANTROSTOMY
 RADICAL ANSTROTOMY

21. RADICAL ANTROSTOMY
 Under GA,
 A large opening is made in
maxillary antrum through
the canine fossa.
 The wall of canine fossa is
opened with
hammer,gouge and then
opening is enlarged with
punch forcep.
 Now pus,diseased mucosa
and polyps are
removed,leaving normal
mucosa undisturbed.

22. ANTRAL PUNCTURE/LAVAGE
 Under LA, trochar with
cannula is inserted into
maxillary sinus through
inf.meatus about ½
inch from its
ant.border.
 Saline water is then
pumped into the sinus
which flows out
through natural ostium.

23. ACUTE FRONTAL SINUSITIS
 Symptoms
 Dull pain occurs in
supraorbital area.starts
in morning and
increases till midday
and tends to disappear
in late afternoon.
 Photophobia,lacrimatio
n
 Nasal discharge
 Fever,malaise
 Signs
 Tenderness over floor
of sinus
 Selling over eyelid and
eyebrow
 On rhinoscopy, local
changes are seen

24. TREATMENT
 Conservative treatment
 Surgical treatment-
 Frontal trephine-an opening is made in the floor
of sinus by giving a small incision just below the
medial end of eyebrow.after drainage, 2 plastic
tubes are inserted into sinus through the wond
and fixed by suturing.tubes are removed after
complete cure
 Functional endoscopic sinus surgery

25. ETHMOIDAL SINUSITIS-ANT. & POST.
 Pain behind the eyes
 Unilateral nasal obstruction
 Mucopurulent/purulent nasal discharge
 fever,headache,malaise
 Tenderness just below inner canthus
 Swelling of skin over nasal bone
 Treatment-
 Intranasal approach
 Frontal ethmoidal approach
 Transantral ethmoidal approach

26. SPHENOIDAL SINUSITIS
 Usually occurs in association with
post.ethmoidal sinusitisor may occur as a part of
generalized sinus infection(pansinusitis)
 Pain is deep in the centre of head
 Pus may seen in sup.meatus on
post.rhinoscopy
 Ant.rhinoscopy-normal
 Treatment-
 conservative
 Intranasal surgical opening of the sphenoidal
sinus in chronic stage.

27. THANK YOU