鼻窦炎英文版培训ppt课件

鼻窦炎英文版鼻窦炎英文版12鼻窦炎英文版2鼻窦炎英文版2Anatomy of the nasal sinuseslAnterior sinus :maxillary sinus maxillary sinus frontal sinus frontal sinus anterior ethmoidal sinusethmoidal sinusThey all open in the middle meatus.They all open in the middle meatus.3鼻窦炎英文版Anatomy of the nasal sinusesAn3lPosterior sinus:posterior ethmoidal sinus:open in ethmoidal sinus:open in the superior meatusthe superior meatus sphenoid sinus:open in sphenoid sinus:open in sphenoethmoidal recesssphenoethmoidal recess4鼻窦炎英文版Posterior sinus:4鼻窦炎英文版4 overviewlSinusitis Sinusitis has has been been defined defined as as an an inflammation inflammation of of the the mucous mucous membrane membrane of of the the sinuses.sinuses.ltwo two types-types-acute acute sinusitis sinusitis and chronic sinusitis.and chronic sinusitis.5鼻窦炎英文版 overviewSinusitis has been d5Acute sinusitisAcute sinusitislAcute inflammation of sinus mucosa lThis commonly follows a cold.lThe sinus most commonly involved is the maxillary followed in turn by ethmoid,frontal and sphenoid.lMultisinusitis:lPansinusitis:6鼻窦炎英文版Acute sinusitisAcute inflamma6lAetiology of sinusitis in general7鼻窦炎英文版Aetiology of sinusitis in gene7Exciting causeslNasal infectionlSwimming and divinglTraumalDental infection8鼻窦炎英文版Exciting causesNasal infection8lPredisposing causes9鼻窦炎英文版Predisposing causes9鼻窦炎英文版9locallObstruction to sinus ventilation and drainage10鼻窦炎英文版localObstruction to sinus vent101、nasal packing11鼻窦炎英文版1、nasal packing11鼻窦炎英文版112、deviated septum12鼻窦炎英文版2、deviated septum12鼻窦炎英文版123、hypertrophic turbinates13鼻窦炎英文版3、hypertrophic turbinates13鼻窦炎134、nasal polypi14鼻窦炎英文版4、nasal polypi14鼻窦炎英文版145、oedema of sinus ostia due to allergy or vasomotor rhinitis 6、benign or malignant neoplasm15鼻窦炎英文版5、oedema of sinus ostia due t15General lEnvironment:atmospheric pollution,smoke,dustlPoor general health nutritional deficiencies systemic disorders(diabets,immune deficiency syndromes)16鼻窦炎英文版General Environment:16鼻窦炎英文版16Bacteriology lViral infection-bacterial invasionlpneumococci,streptococci,H.influenzaelAnaerobic organisms and mixed infections 17鼻窦炎英文版Bacteriology Viral infection-17Pathology of sinusitislAcute inflammation of sinus mucosa causes hyperaemia,exudation of fluid,outpouring of polymorphonuclear cells and increased activity of serous and mucous glands.lDepending on the virulence of organisms,defences of the host and capability of the sinus ostium to drain the exudates,the disease may be mild(none-suppurative)or severe(suppurative)18鼻窦炎英文版Pathology of sinusitisAcute in18lInitially,the exudate is serous;later it may become mucopurulent or purulent.lSevere infections cause destruction of mucosal lining.lFailure of ostium to drain results in empyema of the sinus and destruction of its bony walls leading to complications.19鼻窦炎英文版Initially,the exudate is sero19Acute maxillary sinusitis20鼻窦炎英文版Acute maxillary sinusitis20鼻窦炎20 AetiologylMost commonly,it is viral rhinitis which spreads to involve the sinus mucosa.This is followed by bacterial invasion.lDiving and swimming in contaminated water.lDental infections are important source of maxillary sinusitis.lTrauma 21鼻窦炎英文版 AetiologyMost commonly,it is21Clinical featureslClinical features depend on severity of inflammatory process and efficiency of ostium to drain the exudates.lClosed ostium sinusitis is of greater severity and leads more often to complications.22鼻窦炎英文版Clinical featuresClinical feat22lConstitutional symptoms consist of fever,general malaise and body ache.They are the result of toxaemia.lHeadache lPainlTendernesslRedness and oedema of cheek.lNasal discharge lPost nasal discharge23鼻窦炎英文版Constitutional symptoms consis23Diagnosis X-rays or CT scan:an opacity or a fluid level in the involved sinus.24鼻窦炎英文版Diagnosis X-rays or CT scan:24Treatment25鼻窦炎英文版Treatment25鼻窦炎英文版25Medical26鼻窦炎英文版Medical26鼻窦炎英文版26Antimicrobial drugslAmpicillin or amoxicillinlErythromycin or doxycycline or cotrimoxazolel-lactamase-producing strains of influenzae may necessitate the use of amoxicillin/clavulanic acid lsparfloxacin27鼻窦炎英文版Antimicrobial drugsAmpicillin 27Nasal decongestant dropsl1%ephedrine 28鼻窦炎英文版Nasal decongestant drops1%ep28steroidslAs nasal sprayslAvoid long-term systemic steroids29鼻窦炎英文版steroidsAs nasal sprays29鼻窦炎英文29Steam inhalationlSteam alone provides symptomatic relief and encourage sinus drainage.lInhalation should be given 15 to 20 minutes after decongestion for better penetration.30鼻窦炎英文版Steam inhalationSteam alone pr30AnalgesicslParacetamol 31鼻窦炎英文版AnalgesicsParacetamol 31鼻窦炎英文版31Hot fomentationlLocal heat to the affected sinus is often soothing and helps in the resolution of inflammation.32鼻窦炎英文版Hot fomentationLocal heat to t32SurgicallAntral 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 treatment has failed and only under cover of antibiotics.33鼻窦炎英文版SurgicalAntral puncture and ir3334鼻窦炎英文版34鼻窦炎英文版34complicationslChronic sinusitislOsteomyelitis of the maxillalOrbital cellulitis or abscess35鼻窦炎英文版complicationsChronic sinusitis35lAcute frontal sinusitis36鼻窦炎英文版Acute frontal sinusitis36鼻窦炎英文36AetiologyUsually 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鼻窦炎英文版AetiologyUsually follows viral37Clinical featureslFrontal headachelTendernesslOedema of upper eyelid with suffused conjunctiva and photophobia.lNasal discharge38鼻窦炎英文版Clinical featuresFrontal heada38Treatement 39鼻窦炎英文版Treatement 39鼻窦炎英文版39Medical lThis is same as for acute maxillary sinusitis:antimicrobials,decongestion,analgesics,steroid.lPlacing 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鼻窦炎英文版Medical This is same as for ac40lIf patient shows response to medical treatment and pain is relieved,treatment is continued for full 10 days to 2 weeks.41鼻窦炎英文版If patient shows response to m41Surgical lTrephination 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鼻窦炎英文版Surgical Trephination of front4243鼻窦炎英文版43鼻窦炎英文版43Complications lOrbital cellulitislOsteomyelitis of frontal bone lMeningitis,extradural abscess or frontal lobe abscess.lChronic frontal sinusitis.44鼻窦炎英文版Complications Orbital cellulit44lAcute ethmoid sinusitis45鼻窦炎英文版Acute ethmoid sinusitis45鼻窦炎英文45Aetiology lAcute ethmoiditis is often associated with infection of other sinuses.Ethmoid sinuses are more often involved in infants and young children.46鼻窦炎英文版Aetiology Acute ethmoiditis is46Clinical features lPain lOedema of lidslNasal dischargelSwelling of the middle turbinate47鼻窦炎英文版Clinical features Pain 47鼻窦炎英文47Treatment lMedical treatment is the same as for acute maxillary sinusitis.lVisual deterioration and exophthalmos indicate abscess in the posterior orbit and may require drainage of the ethmoid sinuses into the nose.48鼻窦炎英文版Treatment Medical treatment is48Complications lOrbital cellulitis and abscesslVisual deterioration and blindness due to involvement of optic nerve.lCavernous sinus thrombosis.lExtradural abscess,meningitis or brain abscess.49鼻窦炎英文版Complications Orbital cellulit49lAcute sphenoid sinusitis50鼻窦炎英文版Acute sphenoid sinusitis50鼻窦炎英50Aetiology lIsolated involvement of sphenoid sinus is rare.It is often a part of pansinusitis or is associated with infection of posterior ethmoid sinuses.51鼻窦炎英文版Aetiology Isolated involvement51Clinical featureslHeadache:occiput or vertexlPostnasal discharge52鼻窦炎英文版Clinical featuresHeadache:oc52Differential diagnosisl neoplasms of the sphenoid sinus may clinically simulate features of acute infection of sphenoid sinus and should always be excluded in any case of isolated sphenoid sinus involvement.53鼻窦炎英文版Differential diagnosis neoplas53Treatment 54鼻窦炎英文版Treatment 54鼻窦炎英文版54lChronic sinusitis55鼻窦炎英文版Chronic sinusitis55鼻窦炎英文版55In generallSinus infection lasting for months or years is called chronic sinusitis.Most important cause of chronic sinusitis is failure of acute infection to resolve.56鼻窦炎英文版In generalSinus infection last56pathophysiologylPersistence of infection causes mucosal changes,such as loss of cilia,oedema and polyp formation,thus continuing the vicious cycle.57鼻窦炎英文版pathophysiologyPersistence of 57pathologylIn chronic infections,process of destruction and attempts at healing proceed simultaneously.lSinus mucosa becomes thick and polypoidal or undergoes atrophy.58鼻窦炎英文版pathologyIn chronic infections58Bacteriology lMixed aerobic and anaerobic organism are often present59鼻窦炎英文版Bacteriology Mixed aerobic and59Clinical featureslClinical features are often vague and similar to those of acute sinusitis but of lesser severity.lPurulent nasal discharge is commonest complaint.lFoul-smelling discharge suggests anaerobic infection.60鼻窦炎英文版Clinical featuresClinical feat60lLocal pain and headache are often not marked.lSome patients complain of nasal stuffiness and anosmia.61鼻窦炎英文版Local pain and headache are of61Diagnosis lX-ray or CT scan:mucosal thickening or opacitylAspiration and irrigation:finding of pus in the sinus is confirmatory.62鼻窦炎英文版Diagnosis X-ray or CT scan:62Treatment lIt is essential to search for underlying aetiological factors which obstruct sinus drainage and ventilation.lA workup for nasal allergy may be required.lCulture and sensitivity of sinus discharge helps in the proper selected of an antibiotic.63鼻窦炎英文版Treatment It is essential to s63lInitial treatment of chronic sinusitis is conservative,including antibiotics,decongestants,antihistaminics and steroids.lSome form of surgery is required either to provide free drainage and ventilation or radical surgery to remove all irreversible diseases.64鼻窦炎英文版Initial treatment of chronic s64lRecently,endoscopic sinus surgery is replacing radical operations on the sinuses and provides good drainage and ventilation.It also avoids external incisions.65鼻窦炎英文版Recently,endoscopic sinus su65Surgery 66鼻窦炎英文版Surgery 66鼻窦炎英文版66Chronic maxillary sinusitis67鼻窦炎英文版Chronic maxillary sinusitis67鼻67Antral puncture and irrigation68鼻窦炎英文版Antral puncture and irrigation68Intranasal antrostomy69鼻窦炎英文版Intranasal antrostomy69鼻窦炎英文版69Caldwell-Luc operation70鼻窦炎英文版Caldwell-Luc operation70鼻窦炎英文版70鼻窦炎英文版培训ppt课件71Intranasal drainage operationlCorrection of deviated septum lRemove of a polyplRemove of anterior portion of middle turbinate lIntranasal ethmoidectomy72鼻窦炎英文版Intranasal drainage operationC72Trephination of frontal sinusitis73鼻窦炎英文版Trephination of frontal sinusi73Chronic ethmoid sinusitis74鼻窦炎英文版Chronic ethmoid sinusitis74鼻窦炎74Intronasal ethmoidectomylThe ethmoid air cells and diseased tissue is removed between middle turbinate and the medial wall of orbit by the intranasal route.75鼻窦炎英文版Intronasal ethmoidectomyThe et75External ethmoidectomy76鼻窦炎英文版External ethmoidectomy76鼻窦炎英文版76Chronic sphenoidtislAcess to the sphenoid sinus can be obtained by removal of its anterior wall.77鼻窦炎英文版Chronic sphenoidtisAcess to th77Functional endoscopic surgery of sinuseslostiomeatal complex,OMC78鼻窦炎英文版Functional endoscopic surgery 78uncinectomy79鼻窦炎英文版uncinectomy79鼻窦炎英文版79Open anterior ethmoid sinus80鼻窦炎英文版Open anterior ethmoid sinus80鼻80Enlarge maxillary ostium81鼻窦炎英文版Enlarge maxillary ostium81鼻窦炎英81Open posterior ethmoid sinus82鼻窦炎英文版Open posterior ethmoid sinus8282Open sphenoid sinus83鼻窦炎英文版Open sphenoid sinus83鼻窦炎英文版83Open frontal siuns84鼻窦炎英文版Open frontal siuns84鼻窦炎英文版84question85鼻窦炎英文版question85鼻窦炎英文版85