鼻竇炎英文版鼻竇炎英文版1鼻竇炎英文版培訓(xùn)課件2AnatomyofthenasalsinusesAnteriorsinus

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maxillarysinusfrontalsinusanteriorethmoidalsinusTheyallopeninthemiddlemeatus.AnatomyofthenasalsinusesAn3Posteriorsinus:

posteriorethmoidalsinus:openinthesuperiormeatussphenoidsinus:openinsphenoethmoidalrecessPosteriorsinus:4

overview

Sinusitishasbeendefinedasaninflammationofthemucousmembraneofthesinuses.twotypes-acutesinusitisandchronicsinusitis.overview

Sinusitishasbeend5AcutesinusitisAcuteinflammationofsinusmucosaThiscommonlyfollowsacold.Thesinusmostcommonlyinvolvedisthemaxillaryfollowedinturnbyethmoid,frontalandsphenoid.Multisinusitis:Pansinusitis:AcutesinusitisAcuteinflamma6AetiologyofsinusitisingeneralAetiologyofsinusitisingene7ExcitingcausesNasalinfectionSwimminganddivingTraumaDentalinfectionExcitingcausesNasalinfection8PredisposingcausesPredisposingcauses9localObstructiontosinusventilationanddrainagelocalObstructiontosinusvent101、nasalpacking1、nasalpacking112、deviatedseptum2、deviatedseptum123、hypertrophicturbinates3、hypertrophicturbinates134、nasalpolypi4、nasalpolypi145、oedemaofsinusostiaduetoallergyorvasomotorrhinitis6、benignormalignantneoplasm5、oedemaofsinusostiaduet15GeneralEnvironment:atmosphericpollution,smoke,dustPoorgeneralhealthnutritionaldeficienciessystemicdisorders(diabets,immunedeficiencysyndromes)

GeneralEnvironment:16BacteriologyViralinfection------bacterialinvasionpneumococci,streptococci,H.influenzaeAnaerobicorganismsandmixedinfectionsBacteriologyViralinfection-17PathologyofsinusitisAcuteinflammationofsinusmucosacauseshyperaemia,exudationoffluid,outpouringofpolymorphonuclearcellsandincreasedactivityofserousandmucousglands.Dependingonthevirulenceoforganisms,defencesofthehostandcapabilityofthesinusostiumtodraintheexudates,thediseasemaybemild(none-suppurative)orsevere(suppurative)PathologyofsinusitisAcutein18Initially,theexudateisserous;lateritmaybecomemucopurulentorpurulent.Severeinfectionscausedestructionofmucosallining.Failureofostiumtodrainresultsinempyemaofthesinusanddestructionofitsbonywallsleadingtocomplications.Initially,theexudateissero19AcutemaxillarysinusitisAcutemaxillarysinusitis20AetiologyMostcommonly,itisviralrhinitiswhichspreadstoinvolvethesinusmucosa.Thisisfollowedbybacterialinvasion.Divingandswimmingincontaminatedwater.Dentalinfectionsareimportantsourceofmaxillarysinusitis.TraumaAetiologyMostcommonly,itis21ClinicalfeaturesClinicalfeaturesdependonseverityofinflammatoryprocessandefficiencyofostiumtodraintheexudates.Closedostiumsinusitisisofgreaterseverityandleadsmoreoftentocomplications.ClinicalfeaturesClinicalfeat22Constitutionalsymptomsconsistoffever,generalmalaiseandbodyache.Theyaretheresultoftoxaemia.HeadachePainTendernessRednessandoedemaofcheek.NasaldischargePostnasaldischargeConstitutionalsymptomsconsis23DiagnosisX-raysorCTscan:anopacityorafluidlevelintheinvolvedsinus.DiagnosisX-raysorCTscan:24TreatmentTreatment25MedicalMedical26AntimicrobialdrugsAmpicillinoramoxicillinErythromycinordoxycyclineorcotrimoxazoleβ-lactamase-producingstrainsofinfluenzaemaynecessitatetheuseofamoxicillin/clavulanicacidsparfloxacinAntimicrobialdrugsAmpicillin27Nasaldecongestantdrops1%ephedrineNasaldecongestantdrops1%ep28steroidsAsnasalspraysAvoidlong-termsystemicsteroidssteroidsAsnasalsprays29SteaminhalationSteamaloneprovidessymptomaticreliefandencouragesinusdrainage.Inhalationshouldbegiven15to20minutesafterdecongestionforbetterpenetration.SteaminhalationSteamalonepr30AnalgesicsParacetamol

AnalgesicsParacetamol31HotfomentationLocalheattotheaffectedsinusisoftensoothingandhelpsintheresolutionofinflammation.HotfomentationLocalheattot32SurgicalAntralpunctureandirrigationMostcasesofacutemaxillarysinusitisrespondtomedicaltreatment.Antralpunctureandirrigationisrarelynecessary.Itisdoneonlywhenmedicaltreatmenthasfailedandonlyundercoverofantibiotics.SurgicalAntralpunctureandir33鼻竇炎英文版培訓(xùn)課件34complicationsChronicsinusitisOsteomyelitisofthemaxillaOrbitalcellulitisorabscesscomplicationsChronicsinusitis35AcutefrontalsinusitisAcutefrontalsinusitis36AetiologyUsuallyfollowsviralinfectionsofupperrespiratorytractfollowedlaterbybacterialinvasion.Entryofwaterintothesinusduringdivingorswimming.Externaltraumatothesinus.Oedemaofmiddlemeatus,secondarytoassociatedmaxillaryorethmoidsinusinfection.AetiologyUsuallyfollowsviral37ClinicalfeaturesFrontalheadacheTendernessOedemaofuppereyelidwithsuffusedconjunctivaandphotophobia.NasaldischargeClinicalfeaturesFrontalheada38TreatementTreatement39MedicalThisissameasforacutemaxillarysinusitis:antimicrobials,decongestion,analgesics,steroid.Placingapledgetofcottonsoakedinavasoconstrictorinthemiddlemeatus,onceortwicedaily,helpstorelieveostialoedemaandpromotessinusdrainageandventilation.MedicalThisissameasforac40Ifpatientshowsresponsetomedicaltreatmentandpainisrelieved,treatmentiscontinuedforfull10daysto2weeks.Ifpatientshowsresponsetom41SurgicalTrephinationoffrontalsinus.Ifthereispersistenceofpainorpyrexiainspiteofmedicaltreatmentfor48hours,orifthelidswellingisincreasing,frontalsinusisdrainedexternally.SurgicalTrephinationoffront42鼻竇炎英文版培訓(xùn)課件43ComplicationsOrbitalcellulitisOsteomyelitisoffrontalboneMeningitis,extraduralabscessorfrontallobeabscess.Chronicfrontalsinusitis.ComplicationsOrbitalcellulit44AcuteethmoidsinusitisAcuteethmoidsinusitis45AetiologyAcuteethmoiditisisoftenassociatedwithinfectionofothersinuses.Ethmoidsinusesaremoreofteninvolvedininfantsandyoungchildren.AetiologyAcuteethmoiditisis46ClinicalfeaturesPainOedemaoflidsNasaldischargeSwellingofthemiddleturbinateClinicalfeaturesPain47TreatmentMedicaltreatmentisthesameasforacutemaxillarysinusitis.Visualdeteriorationandexophthalmosindicateabscessintheposteriororbitandmayrequiredrainageoftheethmoidsinusesintothenose.TreatmentMedicaltreatmentis48ComplicationsOrbitalcellulitisandabscessVisualdeteriorationandblindnessduetoinvolvementofopticnerve.Cavernoussinusthrombosis.Extraduralabscess,meningitisorbrainabscess.ComplicationsOrbitalcellulit49AcutesphenoidsinusitisAcutesphenoidsinusitis50AetiologyIsolatedinvolvementofsphenoidsinusisrare.Itisoftenapartofpansinusitisorisassociatedwithinfectionofposteriorethmoidsinuses.AetiologyIsolatedinvolvement51ClinicalfeaturesHeadache:occiputorvertexPostnasaldischargeClinicalfeaturesHeadache:oc52Differentialdiagnosisneoplasmsofthesphenoidsinusmayclinicallysimulatefeaturesofacuteinfectionofsphenoidsinusandshouldalwaysbeexcludedinanycaseofisolatedsphenoidsinusinvolvement.Differentialdiagnosisneoplas53TreatmentTreatment54ChronicsinusitisChronicsinusitis55IngeneralSinusinfectionlastingformonthsoryearsiscalledchronicsinusitis.Mostimportantcauseofchronicsinusitisisfailureofacuteinfectiontoresolve.IngeneralSinusinfectionlast56pathophysiologyPersistenceofinfectioncausesmucosalchanges,suchaslossofcilia,oedemaandpolypformation,thuscontinuingtheviciouscycle.pathophysiologyPersistenceof57pathologyInchronicinfections,processofdestructionandattemptsathealingproceedsimultaneously.Sinusmucosabecomesthickandpolypoidalorundergoesatrophy.pathologyInchronicinfections58BacteriologyMixedaerobicandanaerobicorganismareoftenpresentBacteriologyMixedaerobicand59ClinicalfeaturesClinicalfeaturesareoftenvagueandsimilartothoseofacutesinusitisbutoflesserseverity.Purulentnasaldischargeiscommonestcomplaint.Foul-smellingdischargesuggestsanaerobicinfection.ClinicalfeaturesClinicalfeat60Localpainandheadacheareoftennotmarked.Somepatientscomplainofnasalstuffinessandanosmia.Localpainandheadacheareof61DiagnosisX-rayorCTscan:mucosalthickeningoropacityAspirationandirrigation:findingofpusinthesinusisconfirmatory.DiagnosisX-rayorCTscan:62TreatmentItisessentialtosearchforunderlyingaetiologicalfactorswhichobstructsinusdrainageandventilation.Aworkupfornasalallergymayberequired.Cultureandsensitivityofsinusdischargehelpsintheproperselectedofanantibiotic.TreatmentItisessentialtos63Initialtreatmentofchronicsinusitisisconservative,includingantibiotics,decongestants,antihistaminicsandsteroids.Someformofsurgeryisrequiredeithertoprovidefreedrainageandventilationorradicalsurgerytoremoveallirreversiblediseases.Initialtreatmentofchronics64Recently,endoscopicsinussurgeryisreplacingradicaloperationsonthesinusesandprovidesgooddrainageandventilation.Italsoavoidsexternalincisions.

Recently,endoscopicsinussu65SurgerySurgery66ChronicmaxillarysinusitisChronicmaxillarysinusitis67AntralpunctureandirrigationAntralpunctureandirrigation68IntranasalantrostomyIntranasalantrostomy69Caldwell-LucoperationCaldwell-Lucoperation70ChroicfrontalsinusitisChroic