鼻竇炎英文版培訓(xùn)課件

1、鼻竇炎英文版鼻竇炎英文版2鼻竇炎英文版2鼻竇炎英文版Anatomy of the nasal sinusesAnterior sinus : maxillary sinus frontal sinus anterior ethmoidal sinusThey all open in the middle meatus.3鼻竇炎英文版Anatomy of the nasal sinusesAnPosterior sinus: posterior ethmoidal sinus :open in the superior meatus sphenoid sinus: open in sphenoe

2、thmoidal recess4鼻竇炎英文版Posterior sinus: 4鼻竇炎英文版 overviewSinusitis has been defined as an inflammation of the mucous membrane of the sinuses.two types- acute sinusitis and chronic sinusitis.5鼻竇炎英文版 overviewSinusitis has been dAcute sinusitisAcute inflammation of sinus mucosa This commonly follows a co

3、ld . The sinus most commonly involved is the maxillary followed in turn by ethmoid, frontal and sphenoid.Multisinusitis:Pansinusitis:6鼻竇炎英文版Acute sinusitisAcute inflammaAetiology of sinusitis in general7鼻竇炎英文版Aetiology of sinusitis in geneExciting causesNasal infectionSwimming and divingTraumaDental

4、 infection8鼻竇炎英文版Exciting causesNasal infectionPredisposing causes9鼻竇炎英文版Predisposing causes9鼻竇炎英文版localObstruction to sinus ventilation and drainage10鼻竇炎英文版localObstruction to sinus vent1、nasal packing11鼻竇炎英文版1、nasal packing11鼻竇炎英文版2、deviated septum12鼻竇炎英文版2、deviated septum12鼻竇炎英文版3、hypertrophic tu

5、rbinates13鼻竇炎英文版3、hypertrophic turbinates13鼻竇炎4、nasal polypi14鼻竇炎英文版4、nasal polypi14鼻竇炎英文版5 、oedema of sinus ostia due to allergy or vasomotor rhinitis 6、 benign or malignant neoplasm15鼻竇炎英文版5 、oedema of sinus ostia due tGeneral Environment : atmospheric pollution , smoke , dustPoor general health n

6、utritional deficiencies systemic disorders( diabets, immune deficiency syndromes) 16鼻竇炎英文版General Environment : 16鼻竇炎英文版Bacteriology Viral infection -bacterial invasionpneumococci, streptococci, H. influenzaeAnaerobic organisms and mixed infections 17鼻竇炎英文版Bacteriology Viral infection -Pathology of

7、sinusitisAcute inflammation of sinus mucosa causes hyperaemia, exudation of fluid , outpouring of polymorphonuclear cells and increased activity of serous and mucous glands.Depending on the virulence of organisms, defences of the host and capability of the sinus ostium to drain the exudates, the dis

8、ease may be mild (none-suppurative) or severe( suppurative)18鼻竇炎英文版Pathology of sinusitisAcute inInitially ,the exudate is serous; later it may become mucopurulent or purulent.Severe infections cause destruction of mucosal lining. Failure of ostium to drain results in empyema of the sinus and destru

9、ction of its bony walls leading to complications.19鼻竇炎英文版Initially ,the exudate is seroAcute maxillary sinusitis20鼻竇炎英文版Acute maxillary sinusitis20鼻竇炎 AetiologyMost commonly, it is viral rhinitis which spreads to involve the sinus mucosa. This is followed by bacterial invasion.Diving and swimming in

10、 contaminated water.Dental infections are important source of maxillary sinusitis. Trauma 21鼻竇炎英文版 AetiologyMost commonly, it isClinical featuresClinical features depend on severity of inflammatory process and efficiency of ostium to drain the exudates.Closed ostium sinusitis is of greater severity

11、and leads more often to complications.22鼻竇炎英文版Clinical featuresClinical featConstitutional symptoms consist of fever, general malaise and body ache. They are the result of toxaemia.Headache PainTendernessRedness and oedema of cheek.Nasal discharge Post nasal discharge23鼻竇炎英文版Constitutional symptoms

12、consisDiagnosis X-rays or CT scan : an opacity or a fluid level in the involved sinus.24鼻竇炎英文版Diagnosis X-rays or CT scan : Treatment25鼻竇炎英文版Treatment25鼻竇炎英文版Medical26鼻竇炎英文版Medical26鼻竇炎英文版Antimicrobial drugsAmpicillin or amoxicillinErythromycin or doxycycline or cotrimoxazole -lactamase-producing st

13、rains of influenzae may necessitate the use of amoxicillin/clavulanic acid sparfloxacin27鼻竇炎英文版Antimicrobial drugsAmpicillin Nasal decongestant drops1% ephedrine 28鼻竇炎英文版Nasal decongestant drops1% epsteroidsAs nasal spraysAvoid long-term systemic steroids29鼻竇炎英文版steroidsAs nasal sprays29鼻竇炎英文Steam i

14、nhalationSteam alone provides symptomatic relief and encourage sinus drainage.Inhalation should be given 15 to 20 minutes after decongestion for better penetration.30鼻竇炎英文版Steam inhalationSteam alone prAnalgesicsParacetamol 31鼻竇炎英文版AnalgesicsParacetamol 31鼻竇炎英文版Hot fomentationLocal heat to the affec

15、ted sinus is often soothing and helps in the resolution of inflammation.32鼻竇炎英文版Hot fomentationLocal heat to tSurgicalAntral puncture and irrigationMost cases of acute maxillary sinusitis respond to medical treatment. Antral puncture and irrigation is rarely necessary. It is done only when medical t

16、reatment has failed and only under cover of antibiotics.33鼻竇炎英文版SurgicalAntral puncture and ir34鼻竇炎英文版34鼻竇炎英文版complicationsChronic sinusitisOsteomyelitis of the maxillaOrbital cellulitis or abscess35鼻竇炎英文版complicationsChronic sinusitisAcute frontal sinusitis36鼻竇炎英文版Acute frontal sinusitis36鼻竇炎英文Aeti

17、ologyUsually follows viral infections of upper respiratory tract followed later by bacterial invasion.Entry of water into the sinus during diving or swimming.External trauma to the sinus.Oedema of middle meatus,secondary to associated maxillary or ethmoid sinus infection.37鼻竇炎英文版AetiologyUsually fol

18、lows viralClinical featuresFrontal headacheTendernessOedema of upper eyelid with suffused conjunctiva and photophobia.Nasal discharge38鼻竇炎英文版Clinical featuresFrontal headaTreatement 39鼻竇炎英文版Treatement 39鼻竇炎英文版Medical This is same as for acute maxillary sinusitis: antimicrobials, decongestion ,analge

19、sics, steroid .Placing a pledget of cotton soaked in a vasoconstrictor in the middle meatus,once or twice daily,helps to relieve ostial oedema and promotes sinus drainage and ventilation.40鼻竇炎英文版Medical This is same as for acIf patient shows response to medical treatment and pain is relieved ,treatm

20、ent is continued for full 10 days to 2 weeks.41鼻竇炎英文版If patient shows response to mSurgical Trephination of frontal sinus.If there is persistence of pain or pyrexia in spite of medical treatment for 48 hours, or if the lid swelling is increasing , frontal sinus is drained externally.42鼻竇炎英文版Surgical

21、 Trephination of front43鼻竇炎英文版43鼻竇炎英文版Complications Orbital cellulitisOsteomyelitis of frontal bone Meningitis , extradural abscess or frontal lobe abscess.Chronic frontal sinusitis.44鼻竇炎英文版Complications Orbital cellulitAcute ethmoid sinusitis45鼻竇炎英文版Acute ethmoid sinusitis45鼻竇炎英文Aetiology Acute eth

22、moiditis is often associated with infection of other sinuses. Ethmoid sinuses are more often involved in infants and young children. 46鼻竇炎英文版Aetiology Acute ethmoiditis isClinical features Pain Oedema of lidsNasal dischargeSwelling of the middle turbinate47鼻竇炎英文版Clinical features Pain 47鼻竇炎英文Treatme

23、nt Medical treatment is the same as for acute maxillary sinusitis.Visual deterioration and exophthalmos indicate abscess in the posterior orbit and may require drainage of the ethmoid sinuses into the nose.48鼻竇炎英文版Treatment Medical treatment isComplications Orbital cellulitis and abscessVisual deter

24、ioration and blindness due to involvement of optic nerve .Cavernous sinus thrombosis.Extradural abscess, meningitis or brain abscess.49鼻竇炎英文版Complications Orbital cellulitAcute sphenoid sinusitis50鼻竇炎英文版Acute sphenoid sinusitis50鼻竇炎英Aetiology Isolated involvement of sphenoid sinus is rare . It is of

25、ten a part of pansinusitis or is associated with infection of posterior ethmoid sinuses.51鼻竇炎英文版Aetiology Isolated involvementClinical featuresHeadache : occiput or vertexPostnasal discharge52鼻竇炎英文版Clinical featuresHeadache : ocDifferential diagnosis neoplasms of the sphenoid sinus may clinically si

26、mulate features of acute infection of sphenoid sinus and should always be excluded in any case of isolated sphenoid sinus involvement.53鼻竇炎英文版Differential diagnosis neoplasTreatment 54鼻竇炎英文版Treatment 54鼻竇炎英文版Chronic sinusitis55鼻竇炎英文版Chronic sinusitis55鼻竇炎英文版In generalSinus infection lasting for mont

27、hs or years is called chronic sinusitis. Most important cause of chronic sinusitis is failure of acute infection to resolve.56鼻竇炎英文版In generalSinus infection lastpathophysiologyPersistence of infection causes mucosal changes, such as loss of cilia , oedema and polyp formation, thus continuing the vi

28、cious cycle.57鼻竇炎英文版pathophysiologyPersistence of pathologyIn chronic infections , process of destruction and attempts at healing proceed simultaneously.Sinus mucosa becomes thick and polypoidal or undergoes atrophy.58鼻竇炎英文版pathologyIn chronic infectionsBacteriology Mixed aerobic and anaerobic organ

29、ism are often present59鼻竇炎英文版Bacteriology Mixed aerobic andClinical featuresClinical features are often vague and similar to those of acute sinusitis but of lesser severity. Purulent nasal discharge is commonest complaint. Foul-smelling discharge suggests anaerobic infection. 60鼻竇炎英文版Clinical featur

30、esClinical featLocal pain and headache are often not marked . Some patients complain of nasal stuffiness and anosmia.61鼻竇炎英文版Local pain and headache are ofDiagnosis X-ray or CT scan : mucosal thickening or opacityAspiration and irrigation: finding of pus in the sinus is confirmatory.62鼻竇炎英文版Diagnosi

31、s X-ray or CT scan : Treatment It is essential to search for underlying aetiological factors which obstruct sinus drainage and ventilation. A workup for nasal allergy may be required.Culture and sensitivity of sinus discharge helps in the proper selected of an antibiotic.63鼻竇炎英文版Treatment It is esse

32、ntial to sInitial treatment of chronic sinusitis is conservative, including antibiotics, decongestants, antihistaminics and steroids . Some form of surgery is required either to provide free drainage and ventilation or radical surgery to remove all irreversible diseases.64鼻竇炎英文版Initial treatment of

33、chronic sRecently , endoscopic sinus surgery is replacing radical operations on the sinuses and provides good drainage and ventilation. It also avoids external incisions. 65鼻竇炎英文版Recently , endoscopic sinus suSurgery 66鼻竇炎英文版Surgery 66鼻竇炎英文版Chronic maxillary sinusitis67鼻竇炎英文版Chronic maxillary sinusitis67鼻Antral puncture and irrigation68鼻竇炎英文版Antral puncture and irrigationIntranasal antrostomy69鼻竇炎英文版Intranasal antrostomy69鼻竇炎英文版Caldwell-Luc operation70鼻竇炎英文版Caldwell-Luc operation70鼻竇炎英文版鼻竇炎英文版培訓(xùn)課件Intranasal drainage operationCorrection of deviat