Acute Sinusitis
Definition:Acute inflammation of the mucoperiosteum lining thepara nasal sinuses.
Aetiology:
Causative organisms:
· Streptococcus Pneumonia followed byHaemophilus influenza and moraxellacatarrhalis and others.
· Anaerobes organisms in case maxillary sinusitis wasof dental origin.
Source of infection:
I. Nasal:
a. Acute rhinitis is the commonest.
b. Nasal packing for long time.
c. Nasal foreign body.
2. Dental:
Unilateral maxillary sinusitis mostly is an anerobic infection through:
1. Dental infection: of upper second premolar or first molar tooth.
2. Oro-antralfistula:after extraction of the upper second premolar or first molar teeth.
3. Traumatic: Fracture of the sinus, sinus foreign body, sinus barotraumas.
Pathology: Acute catarrhal followed by suppurative sinusitis: There is congestion and oedema of the sinus mucosa with inflammatory exudates. Oedema leads to occlusion of the ostium, retention of exudates insidethe sinuses,then may pus formation by suppurativemicroorganisms.
Clinicalfeatures:
Symptoms:
Nasal obstruction,nasal dischargewhich is mucopurulent and may be fetid as in maxillary sinusitis due to dental origin, and postnasal mucopurulentdrip.
Fever, facial pain and headache, pain is usually over the affected sinus as following: Maxillary sinusitis: the pain is over the cheek and referred to ears and teeth, in frontal sinusitis: it over the forehead and headache it starts in the morning increased on bending, and subsides at noon, in ethmoidal sinusitis it’s found in-between eyes, while in sphenoidal sinusitis the pain is retro-orbital and occipital.
Signs:
1- Swelling and redness of the skin tenderness elicited over the affected sinus: as over the cheek in maxillary sinusitis, on the floor of the frontal sinus in frontal sinusitis, while in ethmoidal sinusitis it is found medial to the innercanthus(the area between the eye and the nose).
2- Nasal cavity examination:
a) Generalized swelling andhyperaemia of the nasal mucosa over the turbinates.
b) Mucopurulent discharge: in middle meatus as seen in maxillary, frontal, anterior and middle ethmoidal sinusitis, and it seen in superior meatus, as in posterior ethmoidal sinusitis, while if it seen in sphenoethmoidal recess this is due to sphenoidal sinusitis.
3. Postnasal mucopurulent drip as detected by posterior rhinoscopy.
Investigations:
1. Culture and sensitivity test of the nasal discharge.
2. X-ray for sinuses: air-fluid level, thickened mucosa, orTotal opacityof the affected sinus.
Treatment:
Medical: To control the infection, to decrease oedema around the ostium and help sinus drainage and ventilation.
1-Antibiotics: As Amoxicillin 500 mg three time daily for 10 days, and if allergic to penicillin, in this condition we can use Co-trimoxazole two tablet twice daily, or Erythromycin.
2- Analgesics and antipyretics: as paracetamol.
3- Systemic decongestants and antihistamines preparation: as Pseudoepiphdrine.
4- Decongestive nasal drops: as OxymetazolineorXylometazoline nasal drop.
Surgical:
Indications: to drain infected sinus in case of:
1. Failed adequate medical treatment.
2. Threatened complications of sinusitis.
To remove the pus, restore theciliary activity, and to ventilate the sinus, as : Antral washout which may be used in maxillary sinusitis, alsotrephine the floor of frontal sinus in case of frontal sinusitis, while in other types of sinusitis, the lavage is impractical.
COMPLICATIONS
1- Cellulitis of the subcutaneous tissue of the face.
2- Mucocoele: frontal sinus mucocole in adult and ethmoidal sinus mucocoele in children.
3- Dental complication: as oro- antral fistula.
4- Orbital Complications:as
a. Eyelid cellulitis(preseptalcellulitis).
b. Orbital cellulitis (postseptalcellulitis).
c. Subperiosteal abscess.
d. Orbital abscess.
5- Osteomyelitis; In adult osteomylitis of frontal bone (puffy potts tumor), and in children osteomyelitis of maxilla.
6- Pulmonary complications,
7- Intracranial Complications:Meningitis, extradural abscess, subdural abscess, brain abscess, and cavernous sinus thrombosis.
8- Chronic sinusitis.
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x- ray finding of acute right maxillary sinusitis ( total opaque sinus)
x- ray finding of acute right maxillary sinusitis (air-fluid level)