鼻竇炎英文版課件

sinusitis

1sinusitis122AnatomyofthenasalsinusesAnteriorsinus

:

maxillarysinusfrontalsinusanteriorethmoidalsinusTheyallopeninthemiddlemeatus.3AnatomyofthenasalsinusesAnPosteriorsinus:

posteriorethmoidalsinus:openinthesuperiormeatussphenoidsinus:openinsphenoethmoidalrecess4Posteriorsinus:4

overview

Sinusitishasbeendefinedasaninflammationofthemucousmembraneofthesinuses.twotypes-acutesinusitisandchronicsinusitis.5overview

SinusitishasbeendAcutesinusitisAcuteinflammationofsinusmucosaThiscommonlyfollowsacold.Thesinusmostcommonlyinvolvedisthemaxillaryfollowedinturnbyethmoid,frontalandsphenoid.Multisinusitis:Pansinusitis:6AcutesinusitisAcuteinflammaAetiologyofsinusitisingeneral7AetiologyofsinusitisingeneExcitingcausesNasalinfectionSwimminganddivingTraumaDentalinfection8ExcitingcausesNasalinfectionPredisposingcauses9Predisposingcauses9localObstructiontosinusventilationanddrainage10localObstructiontosinusvent1、nasalpacking111、nasalpacking112、deviatedseptum122、deviatedseptum123、hypertrophicturbinates133、hypertrophicturbinates134、nasalpolypi144、nasalpolypi145、oedemaofsinusostiaduetoallergyorvasomotorrhinitis6、benignormalignantneoplasm155、oedemaofsinusostiaduetGeneralEnvironment:atmosphericpollution,smoke,dustPoorgeneralhealthnutritionaldeficienciessystemicdisorders(diabets,immunedeficiencysyndromes)

16GeneralEnvironment:16BacteriologyViralinfection------bacterialinvasionpneumococci,streptococci,H.influenzaeAnaerobicorganismsandmixedinfections17BacteriologyViralinfection-PathologyofsinusitisAcuteinflammationofsinusmucosacauseshyperaemia,exudationoffluid,outpouringofpolymorphonuclearcellsandincreasedactivityofserousandmucousglands.Dependingonthevirulenceoforganisms,defencesofthehostandcapabilityofthesinusostiumtodraintheexudates,thediseasemaybemild(none-suppurative)orsevere(suppurative)18PathologyofsinusitisAcuteinInitially,theexudateisserous;lateritmaybecomemucopurulentorpurulent.Severeinfectionscausedestructionofmucosallining.Failureofostiumtodrainresultsinempyemaofthesinusanddestructionofitsbonywallsleadingtocomplications.19Initially,theexudateisseroAcutemaxillarysinusitis20Acutemaxillarysinusitis20AetiologyMostcommonly,itisviralrhinitiswhichspreadstoinvolvethesinusmucosa.Thisisfollowedbybacterialinvasion.Divingandswimmingincontaminatedwater.Dentalinfectionsareimportantsourceofmaxillarysinusitis.Trauma21AetiologyMostcommonly,itisClinicalfeaturesClinicalfeaturesdependonseverityofinflammatoryprocessandefficiencyofostiumtodraintheexudates.Closedostiumsinusitisisofgreaterseverityandleadsmoreoftentocomplications.22ClinicalfeaturesClinicalfeatConstitutionalsymptomsconsistoffever,generalmalaiseandbodyache.Theyaretheresultoftoxaemia.HeadachePainTendernessRednessandoedemaofcheek.NasaldischargePostnasaldischarge23ConstitutionalsymptomsconsisDiagnosisX-raysorCTscan:anopacityorafluidlevelintheinvolvedsinus.24DiagnosisX-raysorCTscan:Treatment25Treatment25Medical26Medical26AntimicrobialdrugsAmpicillinoramoxicillinErythromycinordoxycyclineorcotrimoxazoleβ-lactamase-producingstrainsofinfluenzaemaynecessitatetheuseofamoxicillin/clavulanicacidsparfloxacin27AntimicrobialdrugsAmpicillinNasaldecongestantdrops1%ephedrine28Nasaldecongestantdrops1%epsteroidsAsnasalspraysAvoidlong-termsystemicsteroids29steroidsAsnasalsprays29SteaminhalationSteamaloneprovidessymptomaticreliefandencouragesinusdrainage.Inhalationshouldbegiven15to20minutesafterdecongestionforbetterpenetration.30SteaminhalationSteamaloneprAnalgesicsParacetamol

31AnalgesicsParacetamol31HotfomentationLocalheattotheaffectedsinusisoftensoothingandhelpsintheresolutionofinflammation.32HotfomentationLocalheattotSurgicalAntralpunctureandirrigationMostcasesofacutemaxillarysinusitisrespondtomedicaltreatment.Antralpunctureandirrigationisrarelynecessary.Itisdoneonlywhenmedicaltreatmenthasfailedandonlyundercoverofantibiotics.33SurgicalAntralpunctureandir3434complicationsChronicsinusitisOsteomyelitisofthemaxillaOrbitalcellulitisorabscess35complicationsChronicsinusitisAcutefrontalsinusitis36Acutefrontalsinusitis36AetiologyUsuallyfollowsviralinfectionsofupperrespiratorytractfollowedlaterbybacterialinvasion.Entryofwaterintothesinusduringdivingorswimming.Externaltraumatothesinus.Oedemaofmiddlemeatus,secondarytoassociatedmaxillaryorethmoidsinusinfection.37AetiologyUsuallyfollowsviralClinicalfeaturesFrontalheadacheTendernessOedemaofuppereyelidwithsuffusedconjunctivaandphotophobia.Nasaldischarge38ClinicalfeaturesFrontalheadaTreatement39Treatement39MedicalThisissameasforacutemaxillarysinusitis:antimicrobials,decongestion,analgesics,steroid.Placingapledgetofcottonsoakedinavasoconstrictorinthemiddlemeatus,onceortwicedaily,helpstorelieveostialoedemaandpromotessinusdrainageandventilation.40MedicalThisissameasforacIfpatientshowsresponsetomedicaltreatmentandpainisrelieved,treatmentiscontinuedforfull10daysto2weeks.41IfpatientshowsresponsetomSurgicalTrephinationoffrontalsinus.Ifthereispersistenceofpainorpyrexiainspiteofmedicaltreatmentfor48hours,orifthelidswellingisincreasing,frontalsinusisdrainedexternally.42SurgicalTrephinationoffront4343ComplicationsOrbitalcellulitisOsteomyelitisoffrontalboneMeningitis,extraduralabscessorfrontallobeabscess.Chronicfrontalsinusitis.44ComplicationsOrbitalcellulitAcuteethmoidsinusitis45Acuteethmoidsinusitis45AetiologyAcuteethmoiditisisoftenassociatedwithinfectionofothersinuses.Ethmoidsinusesaremoreofteninvolvedininfantsandyoungchildren.46AetiologyAcuteethmoiditisisClinicalfeaturesPainOedemaoflidsNasaldischargeSwellingofthemiddleturbinate47ClinicalfeaturesPain47TreatmentMedicaltreatmentisthesameasforacutemaxillarysinusitis.Visualdeteriorationandexophthalmosindicateabscessintheposteriororbitandmayrequiredrainageoftheethmoidsinusesintothenose.48TreatmentMedicaltreatmentisComplicationsOrbitalcellulitisandabscessVisualdeteriorationandblindnessduetoinvolvementofopticnerve.Cavernoussinusthrombosis.Extraduralabscess,meningitisorbrainabscess.49ComplicationsOrbitalcellulitAcutesphenoidsinusitis50Acutesphenoidsinusitis50AetiologyIsolatedinvolvementofsphenoidsinusisrare.Itisoftenapartofpansinusitisorisassociatedwithinfectionofposteriorethmoidsinuses.51AetiologyIsolatedinvolvementClinicalfeaturesHeadache:occiputorvertexPostnasaldischarge52ClinicalfeaturesHeadache:ocDifferentialdiagnosisneoplasmsofthesphenoidsinusmayclinicallysimulatefeaturesofacuteinfectionofsphenoidsinusandshouldalwaysbeexcludedinanycaseofisolatedsphenoidsinusinvolvement.53DifferentialdiagnosisneoplasTreatment54Treatment54Chronicsinusitis55Chronicsinusitis55IngeneralSinusinfectionlastingformonthsoryearsiscalledchronicsinusitis.Mostimportantcauseofchronicsinusitisisfailureofacuteinfectiontoresolve.56IngeneralSinusinfectionlastpathophysiologyPersistenceofinfectioncausesmucosalchanges,suchaslossofcilia,oedemaandpolypformation,thuscontinuingtheviciouscycle.57pathophysiologyPersistenceofpathologyInchronicinfections,processofdestructionandattemptsathealingproceedsimultaneously.Sinusmucosabecomesthickandpolypoidalorundergoesatrophy.58pathologyInchronicinfectionsBacteriologyMixedaerobicandanaerobicorganismareoftenpresent59BacteriologyMixedaerobicandClinicalfeaturesClinicalfeaturesareoftenvagueandsimilartothoseofacutesinusitisbutoflesserseverity.Purulentnasaldischargeiscommonestcomplaint.Foul-smellingdischargesuggestsanaerobicinfection.60ClinicalfeaturesClinicalfeatLocalpainandheadacheareoftennotmarked.Somepatientscomplainofnasalstuffinessandanosmia.61LocalpainandheadacheareofDiagnosisX-rayorCTscan:mucosalthickeningoropacityAspirationandirrigation:findingofpusinthesinusisconfirmatory.62DiagnosisX-rayorCTscan:TreatmentItisessentialtosearchforunderlyingaetiologicalfactorswhichobstructsinusdrainageandventilation.Aworkupfornasalallergymayberequired.Cultureandsensitivityofsinusdischargehelpsintheproperselectedofanantibiotic.63TreatmentItisessentialtosInitialtreatmentofchronicsinusitisisconservative,includingantibiotics,decongestants,antihistaminicsandsteroids.Someformofsurgeryisrequiredeithertoprovidefreedrainageandventilationorradicalsurgerytoremoveallirreversiblediseases.64InitialtreatmentofchronicsRecently,endoscopicsinussurgeryisreplacingradicaloperationsonthesinusesandprovidesgooddrainageandventilation.Italsoavoidsexternalincisions.

65Recently,endoscopicsinussuSurgery66Surgery66Chronicmaxillarysinusitis67Chronicmaxillarysinusitis67Antralpunctureandirrigation68AntralpunctureandirrigationIntranasalantrostomy69Intranasalantrostomy69Caldwell-Lucoperation70Caldwell-Lucoperation70Chroicfrontalsinusitis71Chroicfrontalsinusitis71IntranasaldrainageoperationCorrectionofdeviatedseptumRemoveofapolypRemoveofanteriorportionofmiddleturbinateIntranasalethmoidectomy72IntranasaldrainageoperationCTrephinationoffrontalsinusitis73TrephinationoffrontalsinusiChronicethmoidsinusitis74Chronicethmoidsinusitis74IntronasalethmoidectomyTheethmoidaircellsanddiseasedtissueisremovedbetweenmiddleturbinateandthemedialwalloforbitbytheintranasalroute.75IntronasalethmoidectomyTheetExternalethmoidectomy76Externalethmoidectomy76ChronicsphenoidtisAcesstothesphenoidsinuscanbeobtainedbyremovalofitsanteriorwall.77ChronicsphenoidtisAcesstothFunctionalendoscopicsurgeryofsinuses

ostiomeatalcomplex,OMC78Functionalendoscopicsurgeryuncinectomy79uncinectomy79Openanteriorethmoidsinus80Openanteriorethmoidsinus80Enlargemaxillaryostium81Enlargemaxillaryostium81Openposteriorethmoidsinus82Openposteriorethmoidsinus82Opensphenoidsinus83Opensphenoidsinus83Openfrontalsiuns84Openfrontalsiuns84question85question85

sinusitis

86sinusitis1872AnatomyofthenasalsinusesAnteriorsinus

:

maxillarysinusfrontalsinusanteriorethmoidalsinusTheyallopeninthemiddlemeatus.88AnatomyofthenasalsinusesAnPosteriorsinus:

posteriorethmoidalsinus:openinthesuperiormeatussphenoidsinus:openinsphenoethmoidalrecess89Posteriorsinus:4

overview

Sinusitishasbeendefinedasaninflammationofthemucousmembraneofthesinuses.twotypes-acutesinusitisandchronicsinusitis.90overview

SinusitishasbeendAcutesinusitisAcuteinflammationofsinusmucosaThiscommonlyfollowsacold.Thesinusmostcommonlyinvolvedisthemaxillaryfollowedinturnbyethmoid,frontalandsphenoid.Multisinusitis:Pansinusitis:91AcutesinusitisAcuteinflammaAetiologyofsinusitisingeneral92AetiologyofsinusitisingeneExcitingcausesNasalinfectionSwimminganddivingTraumaDentalinfection93ExcitingcausesNasalinfectionPredisposingcauses94Predisposingcauses9localObstructiontosinusventilationanddrainage95localObstructiontosinusvent1、nasalpacking961、nasalpacking112、deviatedseptum972、deviatedseptum123、hypertrophicturbinates983、hypertrophicturbinates134、nasalpolypi994、nasalpolypi145、oedemaofsinusostiaduetoallergyorvasomotorrhinitis6、benignormalignantneoplasm1005、oedemaofsinusostiaduetGeneralEnvironment:atmosphericpollution,smoke,dustPoorgeneralhealthnutritionaldeficienciessystemicdisorders(diabets,immunedeficiencysyndromes)

101GeneralEnvironment:16BacteriologyViralinfection------bacterialinvasionpneumococci,streptococci,H.influenzaeAnaerobicorganismsandmixedinfections102BacteriologyViralinfection-PathologyofsinusitisAcuteinflammationofsinusmucosacauseshyperaemia,exudationoffluid,outpouringofpolymorphonuclearcellsandincreasedactivityofserousandmucousglands.Dependingonthevirulenceoforganisms,defencesofthehostandcapabilityofthesinusostiumtodraintheexudates,thediseasemaybemild(none-suppurative)orsevere(suppurative)103PathologyofsinusitisAcuteinInitially,theexudateisserous;lateritmaybecomemucopurulentorpurulent.Severeinfectionscausedestructionofmucosallining.Failureofostiumtodrainresultsinempyemaofthesinusanddestructionofitsbonywallsleadingtocomplications.104Initially,theexudateisseroAcutemaxillarysinusitis105Acutemaxillarysinusitis20AetiologyMostcommonly,itisviralrhinitiswhichspreadstoinvolvethesinusmucosa.Thisisfollowedbybacterialinvasion.Divingandswimmingincontaminatedwater.Dentalinfectionsareimportantsourceofmaxillarysinusitis.Trauma106AetiologyMostcommonly,itisClinicalfeaturesClinicalfeaturesdependonseverityofinflammatoryprocessandefficiencyofostiumtodraintheexudates.Closedostiumsinusitisisofgreaterseverityandleadsmoreoftentocomplications.107ClinicalfeaturesClinicalfeatConstitutionalsymptomsconsistoffever,generalmalaiseandbodyache.Theyaretheresultoftoxaemia.HeadachePainTendernessRednessandoedemaofcheek.NasaldischargePostnasaldischarge108ConstitutionalsymptomsconsisDiagnosisX-raysorCTscan:anopacityorafluidlevelintheinvolvedsinus.109DiagnosisX-raysorCTscan:Treatment110Treatment25Medical111Medical26AntimicrobialdrugsAmpicillinoramoxicillinErythromycinordoxycyclineorcotrimoxazoleβ-lactamase-producingstrainsofinfluenzaemaynecessitatetheuseofamoxicillin/clavulanicacidsparfloxacin112AntimicrobialdrugsAmpicillinNasaldecongestantdrops1%ephedrine113Nasaldecongestantdrops1%epsteroidsAsnasalspraysAvoidlong-termsystemicsteroids114steroidsAsnasalsprays29SteaminhalationSteamaloneprovidessymptomaticreliefandencouragesinusdrainage.Inhalationshouldbegiven15to20minutesafterdecongestionforbetterpenetration.115SteaminhalationSteamaloneprAnalgesicsParacetamol

116AnalgesicsParacetamol31HotfomentationLocalheattotheaffectedsinusisoftensoothingandhelpsintheresolutionofinflammation.117HotfomentationLocalheattotSurgicalAntralpunctureandirrigationMostcasesofacutemaxillarysinusitisrespondtomedicaltreatment.Antralpunctureandirrigationisrarelynecessary.Itisdoneonlywhenmedicaltreatmenthasfailedandonlyundercoverofantibiotics.118SurgicalAntralpunctureandir11934complicationsChronicsinusitisOsteomyelitisofthemaxillaOrbitalcellulitisorabscess120complicationsChronicsinusitisAcutefrontalsinusitis121Acutefrontalsinusitis36AetiologyUsuallyfollowsviralinfectionsofupperrespiratorytractfollowedlaterbybacterialinvasion.Entryofwaterintothesinusduringdivingorswimming.Externaltraumatothesinus.Oedemaofmiddlemeatus,secondarytoassociatedmaxillaryorethmoidsinusinfection.122AetiologyUsuallyfollowsviralClinicalfeaturesFrontalheadacheTendernessOedemaofuppereyelidwithsuffusedconjunctivaandphotophobia.Nasaldischarge123ClinicalfeaturesFrontalheadaTreatement124Treatement39MedicalThisissameasforacutemaxillarysinusitis:antimicrobials,decongestion,analgesics,steroid.Placingapledgetofcottonsoakedinavasoconstrictorinthemiddlemeatus,onceortwicedaily,helpstorelieveostialoedemaandpromotessinusdrainageandventilation.125MedicalThisissameasforacIfpatientshowsresponsetomedicaltreatmentandpainisrelieved,treatmentiscontinuedforfull10daysto2weeks.126IfpatientshowsresponsetomSurgicalTrephinationoffrontalsinus.Ifthereispersistenceofpainorpyrexiainspiteofmedicaltreatmentfor48hours,orifthelidswellingisincreasing,frontalsinusisdrainedexternally.127SurgicalTrephinationoffront12843ComplicationsOrbitalcellulitisOsteomyelitisoffrontalboneMeningitis,extraduralabscessorfrontallobeabscess.Chronicfrontalsinusitis.129ComplicationsOrbitalcellulitAcuteethmoidsinusitis130Acuteethmoidsinusitis45AetiologyAcuteethmoiditisisoftenassociatedwithinfectionofothersinuses.Ethmoidsinusesaremoreofteninvolvedininfantsandyoungchildren.131AetiologyAcuteethmoiditisisClinicalfeaturesPainOedemaoflidsNasaldischargeSwellingofthemiddleturbinate132ClinicalfeaturesPain47TreatmentMedicaltreatmentisthesameasforacutemaxillarysinusitis.Visualdeteriorationandexophthalmosindicateabscessintheposteriororbitandmayrequiredrainageoftheethmoidsinusesintothenose.133TreatmentMedicaltreatmentisComplicationsOrbitalcellulitisandabscessVisualdeteriorationandblindnessduetoinvolvementofopticnerve.Cavernoussinusthrombosis.Extraduralabscess,meningitisorbrainabscess.134ComplicationsOrbitalcellulitAcutesphenoidsinusitis135Acutesphenoidsinusitis50AetiologyIsolatedinvolvementofsphenoidsinusisrare.Itisoftenapartofpansinusitisorisassociatedwithinfectionofposteriorethmoidsinuses.136AetiologyIsolatedinvolvementClinicalfeaturesHeadache:occiputorvertexPostnasaldischarge137ClinicalfeaturesHeadache:ocDifferentialdiagnosisneoplasmsofthesphenoidsinusmayclinicallysimulatefeaturesofacuteinfectionofsphenoidsinusandshouldalwaysbeexcludedinanycaseofisolatedsphenoidsinusinvolvement.138DifferentialdiagnosisneoplasTreatment139Treatment54Chronicsinusitis140Chronicsinusitis55IngeneralSinusinfectionlastingformonthsoryearsiscalledchronicsinusitis.Mostimportantcauseofchronicsinusitisisfailureofacuteinfectiontoresolve.141IngeneralSinusinfectionlastpathophysiologyPersistenceofinfectioncausesmucosalchanges,suchaslossofcilia,oedemaandpolypformation,thuscontinuingtheviciouscycle.142pathophysiologyPersistenceofpathologyInchronicinfections,processofdestructionandattemptsathealingproceedsimultaneously.Sinusmucosabecomesthickandpolypoidalorundergoesatrophy.143pathologyInchronicinfectionsBacteriologyMixedaerobicandanaerobicorganismareoftenpresent144BacteriologyMixedaerobicandClinicalfeaturesClinicalfeaturesareoftenvagueandsimilartothoseofacutesinusitisbutoflesserseverity.Purulentnasaldischargeiscommonestcomplaint.Foul-smellingdischargesuggestsanaerobicinfection.145ClinicalfeaturesClinicalfeatLocalpainandheadacheareoftennotmarked.Somepatientscomplainofnasalstuffinessandanosmia.146LocalpainandheadacheareofDiagnosisX-rayorCTscan:mucosalthickeningoropacityAspirationandirrigation:findingofpusinthesinusisconfirmatory.147DiagnosisX-rayor