Inflammatory diseases of paranasal sinuses

Acute and Chronic Inflammations of the Paranasal Sinuses

Inflammatory process of the mucous tunic,

the submucous layer and sometimes of the periosteum

and the bone walls of the paranasal sinuses that lasts more than 2 months or recurs 4 and more times a year is classified as chronic sinusitis. As a rule, it is a continuation of an acute process.

A. Exudative forms:
catarral; serous; purulent.

The classification of sinusitis by B.S.Preobrazhenskiy

B. Productive forms:

C. Alternative forms:
cholesteatomic; caseous; necrotic; atrophic

parietal- hyperplastic; polypous cystic;

The classification of sinusitis by B.S.Preobrazhenskiy

D. Mixed forms:
Purulent-polypous; serous - catarral; serous - polypous; parietal- hyperplastic - polypous, etc.

E. Vasomotor and allergic forms

The Most Common Forms of Sinusitis

purulent

purulent polypoid
catarral parietal hyperplastic allergic

What sinuses are affected mostly?

1. 2. 3. 4.

the the the the

maxillary sinus (maxillary sinusitis) ethmoidal sinus (ethmoiditis) frontal sinus (frontal sinusitis) basilar sinus (sphenoiditis)

Etiology
The microorganisms that vegetate on the mucous tunic of the upper airways: staphylococcus, streptococcus, blue pus bacillus, Proteus bacillus, colon bacillus, anaerobes, viruses, fungi.

Causally relevant factors of sinusitis

1)the decrease of the reactivity of the organism; 2)the drainage disfunction of the anastomosis (arcuation of the nasal septum, hypertrophic rhinitis, adenoids); 3)disfunction of the mucous tunic of the nose and the paranasal sinuses. 4)nflammation of the tooth-maxillary system

the inflammation of the mucous tunic of the nasal cavity and the paranasal sinuses the edema of the mucous tunic the closing of the natural anastomosis of the sinuses (the drainage disfunction) the change of the pressure in the sinus (decreasing) the vasodilatation and the transudation of the fluid the migration of the neutrophils with the pus formation (in case of the infection) the development of the sensitizing as a result of the absorption of the toxins

Pathogenesis

Clinical picture
The clinical picture depends on:
the stage of the disease (remission, exacerbation); sinusitis form; localisation of the process; extent of the affection (one or several sinuses); kind and virulence of the microorganisms; permeability of the natural anastomosis.

Clinical picture
Rise in temperature, headache, deterioration of the state of health, pain in the area of the projection of the sinuses, edema of the eyelids, inflammatory shift in blood.

The painful points in the inflammatory diseases of the paranasal sinuses.

Rhinoscopic picture

purulent sinusitis

polypous purulent sinusitis

polypous sinusitis

Diagnostics of Sinusitis
Anamnesis Diagnostic puncturing of the maxillar sinus X-ray (CT)

The conservative treatment

1. 2. 3. 4. 5. Antibacterial therapy anti-inflammatory drugs dehydrating therapy desensitizing therapy symptomatic treatment

6.
7.

vasoconstrictors endonasal
punctures and drainage of the paranasal

sinuses

Surgical Treatment
Operations on the the maxillary sinus: Kaldvell-Lukes operation, Rudakovs operation. Videoendoscopic maxillary sinusotomy

Operations on the ethmoidal sinus: Endonasal polypusethmoidotomy

Kaldvell-Lukes operation

1. incision of the mucous tunic in the area of the vestibule of the mouth

2. opening of the maxillary sinus through its anterior wall

3. application of the anastomosis between the maxillary sinus and the inferior nasal meatus

Operations on the ethmoidal labyrinth

Polypotomy of the nose