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    Add as FriendChronic sinusitis ppt by Dr Manas

    by: Dr Manas Ranjan Rout

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    1 : Dr Manas Chronic Sinusitis
    2 : Definition Long standing inflammation of the Sinus cavity (lasting for months and years) is called Chronic Sinusitis.
    3 : Etiology Failure of Acute Infection to resolve Pollution Virulent organism Allergy Obstruction to sinus Ostium Dysmotility of cilia
    4 : Pathophysiology
    5 : Pathology
    6 : Bacteriology Gram positive Gram negative Anaerobic organism
    7 : Clinical Feature Similar to Acute Sinusitis, but of less severity. Purulent nasal discharge ,often foul smelling Mild headache and pain Nasal Stuffiness Anosmia
    8 : Diagnosis X-Ray PNS X-Ray with contrast CT- Scan Aspiration and Irrigation
    9 : Treatment Treat the Underlying pathology Treatment for Nasal Allergy Culture and Sensitivity of sinus discharge Conservative management Surgery for free drainage and ventilation Radical Surgery Endoscopic Sinus Surgery
    10 : Surgery for Chronic Maxillary Sinusitis Antral puncture and Irrigation Intranasal Antrostomy Caldwell-luc operation
    11 : Surgery for Chronic Frontal Sinusitis Intranasal drainage operation Trephination of Frontal sinus External Fronto-ethmoidectomy (Howarth’s or Lynch operation) Osteoplastic flap operation
    12 : Surgery for Chronic Ethmoid Sinusitis Intranasal Ethmoidectomy External Ethmoidectomy
    13 : Surgery for Chronic Sphenoid Sinusitis Sphenoidotomy
    14 : Fungal Sinusitis Involvement of sinuses by fungus is called fungal sinusitis Causative organism Aspargillus sp Alternaria Mucor Rhizopus
    15 : Promoting Factors Diabetes HIV infection Steroid therapy Other immuno-suppressive therapy Other immuno deficiency state like malnutrition, cancer etc.
    16 : Forms of fungal infection Four different varieties of fungal infections Fungal ball Allergic fungal sinusitis Chronic invasive sinusitis Fulminate sinusitis
    17 : Fungal ball Most commonly maxillary sinus involved followed by Sphenoid,Ethmoid and Frontal. Due to implantation of fungus in to otherwise healthy sinus. No bone erosion found Surgical removal of ball and adequate drainage No anti fungal therapy.
    18 : Fungal ball
    19 : Allergic fungal sinusitis-1 Due to allergic reaction to causative fungus Presents with sinu-nasal polyposis Secretion contains Eosinophils,Charcot-leyden crystal and fungal hyphae Bilateral multiple sinuses may be involved CT scan shows mucosal thickening with hyper dense areas.
    20 : Allergic fungal sinusitis-2 6.There is expansion of sinus and evidence of bone erosion due to pressure. 7.No invasion of fungus 8.Treatment is maintenance of ventilation and drainage 9.Pre and post operative systemic steroids
    21 : Chronic invasive sinusitis Fungus invade in to sinus mucosa Erosion of the bone Presents with Chr.Rhinosinusitis Intracranial and Intraorbital extension Treatment is surgery and antifungal therapy.(Firstly with iv Amphotericin-B followed by oral Itraconazole for 12month or more)
    22 : Fulminant Fungal Sinusitis Found in Immunocompromised or Diabetic individuals Acutely presents Common fungal species are Mucor and Aspergillus Mucor – Ischemic necrosis, Black eschar formation Aspergillus –Tissue invasion and sepsis Treatment – surgery & Antifungal therapy
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    26 : Recent treatment Endoscopic sinus surgery
    27 : Complications of Sinusitis Orbital complications Osteomyelitis Intracranial Descending infections Focal infections
    28 : Orbital Complications Inflammatory oedema of the lid (periorbital cellulitis) Orbital Cellulitis Subperiosteal abscess Orbital abscess Superior Orbital fissure syndrome Orbital apex syndrome
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    31 : Subperiosteal abscess
    32 : Orbital abscess
    33 : Osteomyelitis Osteomyelitis of Maxilla Osteomyelitis of frontal bone
    34 : Osteomyelitis of Maxillary bone
    35 : Osteomyelitis of frontal bone
    36 : Pott's puffy tumor
    37 : Intracranial complications Meningitis and Encephalitis Extradural abscess Subdural abscess Brain abscess Cavernous sinus thrombosis
    38 :
    39 : Brain abscess
    40 : Cavernous sinus thrombosis Secondary to Ethmoid and Sphenoid sinusitis Abrupt onset fever with chill and rigor Eyeball swollen with chemosis and proptosis Opthalmoplegia due to palsy of III,IV and VIth cranial nerves Sensation in the distribution of V1 is diminished Pupil dilated and fixed To be differentiated from orbital cellulitis CT scan is helpful.
    41 :
    42 : Descending infections Otitis media Pharyngitis Tonsillitis Laryngitis Tracheobronchitis
    43 : Focal infections Polyarteritis Tenosinuvitis Fibrositis Chronic skin disease
    44 : Thank you
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