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SINUSITIS & ITS COMPLICATIONS

SINUSITIS & ITS COMPLICATIONS. Sami Alharethy. DEFINITIONS. Acute – the persistence of upper respiratory symptoms for greater than a 7-day course but lasts less than 4 weeks. Subacute - nasal symptoms lasting 4 weeks to 12 weeks

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SINUSITIS & ITS COMPLICATIONS

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  1. SINUSITIS & ITS COMPLICATIONS Sami Alharethy

  2. DEFINITIONS • Acute – the persistence of upper respiratory symptoms for greater than a 7-day course but lasts less than 4 weeks. • Subacute - nasal symptoms lasting 4 weeks to 12 weeks • Chronic– persistence mucosal inflammation for > 12 consecutive weeks despite medical therapy or occurrence of more than 4 episodes a year

  3. Rhinosinusitis Acute Chronic Greater than 3 months S. Aureus,Anerobes α-hemolytic strep, m. catarrhalis Milder symptoms Additional symptoms present: chronic cough, bronchitis, fatigue, malaise, and depression • Less then 3 months • S. Pneumo, H. Flu, M. Catarrhalis • More severe symptoms • General stems from acute viral infection

  4. Signs and Symptoms • Day and night cough • Purulent nasal discharge • Nasal airway obstruction • Headache, irritability, or facial pain • Fever • Postnasal drip

  5. AnatomyMaxillary Sinus Largest and first sinus to develop Natural ostium drains into Middle M First and second molar roots dehiscent in 2%

  6. AnatomyEthmoid Sinus First seen at 5 months gestation Adult size by 12-15 years Between 10-15 cells Drainage Anterior cells via Middle meatus Posterior cells via Superior M

  7. AnatomyFrontal Sinus Not present at birth Starts developing at 4 years Development not complete until 12-20 years Drainage via frontal recess to MM

  8. AnatomySphenoid Sinus Pneumatization begins in middle childhood Reaches adult size by 12-18 years

  9. Pathophysiology Systemic: • Viral URI • Allergy • Immotile cilia • Cystic fibrosis • Immune disorder

  10. Pathophysiology Local: • Trauma • Swimming/Diving • Rhinitis Medicamentosa

  11. Pathophysiology Mechanical: • Choanal Atresia • Deviated Septum • Polyps/Foreign Body • Turbinate/Adenoid Hypertrophy

  12. Mucociliary clearance

  13. Mucociliary clearance • Ciliary function very important • Ostia are small and located in locations not conducive to spont-drainage

  14. Mucociliary clearance • Cilia work best: • Temp of 37° • Humidity near 100% • Respiratory Epithelium • Goblet cells (20%) produce mucus • Ciliated cells (80%)

  15. Decreased MCC • Kartagener syndrome (Primary ciliary dyskinesia) • Cystic fibrosis • Radiotherapy • GERD • Rhinosinusitis

  16. Primary ciliary dyskinesia • Autosomal recessive • Dynein arm defects • Kartagener syndrome (Associated with dextrocardia, sinusitis, rhinitis, pneumonia, and otitis media) • Male infertility is common

  17. Cystic Fibrosis • Autosomal recessive • Decreased chloride secretion with resultant thicker/stickier mucus adherent to bacteria • Viscosity leads to dysfunction: • Resp tract Sweat glands • Pancreas Other exocrine glands • GI tract

  18. Treatment principles • Irrigation and drainage of secretions improve local defense mechanisms • Antimicrobials

  19. Surgical treatment • Conservative FESS

  20. Complications of Sinusitis Three main categories Orbital (60-75%) Intracranial (15-20%) Bony (5-10%) Radiography Computed tomography (CT) best for orbit Magnetic resonance imaging (MRI) best for intracranium

  21. Orbital ComplicationsChandler Criteria Five classifications Preseptal cellulitis Orbital cellulitis Subperiosteal abscess Orbital abscess Cavernous sinus thrombosis

  22. Orbital ComplicationsPreseptal Cellulitis

  23. Orbital ComplicationsOrbital Cellulitis

  24. Orbital ComplicationsSubperiosteal Abscess Surgical drainage Worsening visual acuity or extraocular movement Lack of improvement after 48 hours

  25. Orbital ComplicationsSubperiosteal Abscess Approaches External ethmoidectomy (Lynch incision) is most preferred Endoscopic ideal for medial abscesses Transcaruncular approach

  26. Orbital ComplicationsOrbital Abscess Similar approaches as with subperiosteal abscess Lynch incision Endoscopic

  27. Orbital ComplicationsCavernous Sinus Thrombosis Symptomatology Orbital pain Proptosis and chemosis Ophthalmoplegia Symptoms in contralateral eye Associated with sepsis and meningitis Radiology Better visualized on MRI

  28. Orbital ComplicationsCavernous Sinus Thrombosis Mortality rate up to 30% Surgical drainage Intravenous antibiotics

  29. Complications of SinusitisIntracranial

  30. Intracranial ComplicationsTypes Five types Meningitis Epidural abscess Subdural abscess Intracerebral abscess Cavernous sinus, venous sinus thrombosis

  31. Complications of SinusitisBony Pott’s puffy tumor Frontal sinusitis with acute osteomyelitis Subperiosteal pus collection leads to “puffy” fluctuance Rare complication

  32. Thanks,,,

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