鼻窦炎英文版.pptVIP

Clinical features Clinical features are often vague and similar to those of acute sinusitis but of lesser severity. Purulent nasal discharge is commonest complaint. Foul-smelling discharge suggests anaerobic infection. * Local pain and headache are often not marked . Some patients complain of nasal stuffiness and anosmia. * Diagnosis X-ray or CT scan : mucosal thickening or opacity Aspiration and irrigation: finding of pus in the sinus is confirmatory. * Treatment It is essential to search for underlying aetiological factors which obstruct sinus drainage and ventilation. A workup for nasal allergy may be required. Culture and sensitivity of sinus discharge helps in the proper selected of an antibiotic. * Initial treatment of chronic sinusitis is conservative, including antibiotics, decongestants, antihistaminics and steroids . Some form of surgery is required either to provide free drainage and ventilation or radical surgery to remove all irreversible diseases. * Recently , endoscopic sinus surgery is replacing radical operations on the sinuses and provides good drainage and ventilation. It also avoids external incisions. * Surgery * Chronic maxillary sinusitis * Antral puncture and irrigation * Intranasal antrostomy * Caldwell-Luc operation * Chroic frontal sinusitis * Intranasal drainage operation Correction of deviated septum Remove of a polyp Remove of anterior portion of middle turbinate Intranasal ethmoidectomy * Trephination of frontal sinusitis * Chronic ethmoid sinusitis * Intronasal ethmoidectomy The ethmoid air cells and diseased tissue is removed between middle turbinate and the medial wall of orbit by the intranasal route. * External ethmoidectomy * Chronic sphenoidtis Acess to the sphenoid sinus can be obtained by removal of its anterior wall. * Functional endoscopic surgery of sinuses ostiomeatal complex, OMC * uncinectomy * Open anterior ethmoid sinus * Enlarge maxillary ostium * Open posterior ethmoid sinus * Open sphenoid s