Acute sinusitis ppt

1. ACUTE
SINUSITI
S
-Anira
Iqbal
Batch 2011

3. EMBRYOLOGY
• Begin to develop in 3rd fetal month
• As outpouchings of mucous
membranes of Superior and Middle
Meatus
• 2 processes – Primary pneumatization
Secondary
pneumatization
• Primary – Differential growth 
Diverticular pouches/recesses 
expansion of wall itself to elaborate air
space
• Secondary – Expansion outside wall 
occupies space within craniofacial
bones

4. Sinus Development Primary
pneumatizn
Secondary
pneumatizn
Remarks
Maxillary From middle
meatus
invaginating
into maxilla
10 weeks iu 5 months IU At birth-Clinically
significant(4-8ml),
Radio. Identifiable
Reaches final size by
15 y
Sphenoidal Recess b/w
conchae of
sphenoidal
bone and
sphenoidal
body
4th month IU 6-7 y/o Absent at birth
7 y/o- reaches sella
turcica
15 y – fully dev
Varied degrees of
pneumatization in
adults
Ethmoidal From Sup and
Mid meatus to
nasal capsule
4th month IU 2 y Can be identified at
birth. Fully dev by 20y
Frontal Frontal recess
of middle
meatus
4th month IU 6 mo V.Small at birth. Slow
pneumatization
Fully dev by 20y.

6. OSTEOMEATAL
COMPLEX
• Common channel that links frontal sinus, ant. and
middle ethmoid sinus, and max sinus to middle
meatus  allows air flow and mucociliary drainage 
needs to be patent for drainage of secretions in
sinusitis

9. ACUTE SINUSITIS
• Acute (<4 wks) inflammation of sinus mucosa
• Max.>Ethmoid>Frontal>Sphenoid
• >1 sinus involved mostly – Multisinusitis
• All the sinuses of 1 side – Pansinusitis unilateral
• All the sinuses of both sides – Pansinusitis bilateral
Can be of 2 types :
1. Open – Exudate escapes from sinus through natural
ostia
2. Closed – Exudate cannot escape
- more severe – greater risk of complications

10. ETIOLOGY
EXCITING CAUSES
1. Nasal infections - Nasal mucosa  Sinus mucosa
MCC – Viral >
Bacterial>>Fungal
2. Swimming/Diving – Infected water  Ostia of sinuses
- Chlorine  Chemical
inflammation
3. Trauma – Compound # or penetrating injuries 
infection
4. Dental infection – Molar/Premolar infection/extraction
 Max. sinus

11. PREDISPOSING CAUSES  Local
 General
LOCAL
1. Obstruction to sinus ventilation and drainage
• Nasal packing
• DNS
• Hypertrophic turbinates
• Allergy – oedema of sinus ostia
• Nasal polypi
• Benign/Malignant neoplasm
2. Stasis of secretions in nasal cavity
• Cystic fibrosis – high viscosity of secretions
• Enlarged adenoids - obstruction
• Choanal atresia - obstruction

12. GENERAL
1. Environment – cold, wet
- atm. pollution, smoke, dust,
overcrowding
2. Poor general health – recurrent attacks of exanth.
Fevers
- nutritional deficiencies
- Systemic disorders (Diabetes)
- Immunodeficient
BACTERIOLOGY
• Streptococcus pneumoniae
• Hemophilus influenzae
• Moraxella catarrhalis
• Streptococcus pyogenes
• Staphylococcus aureus
• Klebsiella pneumoniae
• Anaerobic org. – Dental infections

13. PATHOLOGY
Infection  Acute Inflammation of sinus mucosa 
Hyperemia  Exudation (serous 
mucopurulent/purulent)  Outpouring of PMNs 
Increased activity of serous and mucus glands 
severe infection  destruction of mucosal lining
If failure of ostium to drain  Empyema
If destruction of bony walls  complications
• Mild/Non suppurative – less virulent, good immunity,
drainage
• Severe/Suppurative

14. ACUTE MAXILLARY
SINUSITIS
• ‘Antrum of
Highmore’
• Largest
• MC Sinus infected –
drainage pattern
• Pyramidal
• Base – Lat. Wall of
nose
• Apex – Zygomatic
process of maxilla
• *Floor* - Rel. to
molars and
premolars 
extraction 
oroantral fistula

16. ETIOLOGY
1. MCC – Viral rhinitis
2. 2nd MCC – Bacterial invasion
3. Diving/swimming
4. *Dental infections* - Periapical dental abscess
Tooth extraction
5. Trauma – Compound #
Penetrating injuries
Gunshot wounds

17. CLINICAL FEATURES
1. Due to toxemia – Fever
Body ache
Malaise
2. Headache – Forehead ( ~ Frontal)
3. Pain – Over upper jaw/referred to
gums/teeth/ipsilateral supraorbital region (~frontal)
- aggravated by stooping/coughing/chewing
- worse if head upright, relieved if supine
4. Tenderness
5. Redness and oedema of cheek – children – thinner
bone
6. Nasal discharge – Ant. Rhinoscopy/nasal endoscopy
 pus/mucopus in MM  red swollen mucosa
7. Postnasal discharge – Post. Rhinoscopy/Nasal
endoscopy  Pus on upper soft palate

19. DIAGNOSIS
• Transillumination test - Affected sinus  Opaque

20. • X-rays – Water’s view (Occipito-mental view) – Air
fluid level or opacification

23. • CT Scan

24. COMPLICATIONS
1. Subacute/Chronic sinusitis
2. Frontal sinusitis – Oedema  obstruction of OMC 
obstruction of frontal sinus drainage pathway
3. Osteitis/Osteomyelitis of maxilla
4. Orbital cellulitis/abscess – Spread of infection
a. direct – roof of
maxillary sinus
b. indirect –
ethmoid sinus

25. ACUTE FRONTAL
SINUSITIS• B/w inner & outer
table of frontal
bone, above & deep to
supraorbital margin
• Thin bony septum
b/w the 2
asymmetric sinuses
• Drainage  ostium
 frontal recess
(hourglass
structure)
infundibulum 
Middle meatus
• Gravity  heals
faster

27. ETIOLOGY
1. Viral rhinitis
2. Bacterial invasions
3. Diving/Swimming
4. Trauma
5. Ipsilateral Maxillary/Ethmoid sinusitis

28. CLINICAL FEATURES
1. Frontal headache – Medial brow area
‘Office Headache’ – Comes up
on waking  Gradually increases  Peak at mid-day
 Subsides
2. Tenderness – Tapping
- Pressure upwards on floor of frontal
sinus
3. Oedema of upper eyelid
4. Nasal discharge – Nasal endoscopy – vertical streak
of mucopus high up in anterior part of middle
meatus

29. DIAGNOSIS
• X- ray – Water’s view

30. • CT Scan

31. COMPLICATIONS
1. Orbital cellulitis
2. Osteomyelitis of frontal bone and fistula formation
3. Meningitis
4. Extradural abscess
5. Frontal lobe abscess
6. Chronic frontal sinusitis

32. ACUTE ETHMOID
SINUSITIS
• 3 to 18 in no.
• B/w U 1/3 Lateral
nasal wall &
medial wall of
orbit
• V. low capacity
• Ant. Group  MM
• Post. Group  SM

34. ETIOLOGY
• Infection of other sinuses
Clinical Features
1. Pain – bridge of nose – medial and deep to eye
- aggravated by movements of eyeball
- ‘Spectacle tenderness’
2. Oedema of lids
3. Inc lacrimation
4. Nasal discharge – Ant group  pus in MM
Post group  pus in SM 
spreads over post pharyngeal wall

35. COMPLICATIONS
1. Orbital cellulitis and abscess
2. Optic Nerve  Visual deterioration  blindness
3. Cavernous sinus thrombosis
4. Extradural abscess
5. Meningitis
6. Brain abscess

36. • X-ray – Caldwell’s view (Occipito-frontal view)

38. • CT Scan

39. ACUTE SPHENOID
SINUSITIS
• Ostium high up in
ant wall 
Sphenoethmoidal
recess  SM

40. ETIOLOGY
• Isolated involvement – rare
• + Pansinusitis/Post. Ethmoidal sinusitis
Clinical Features
1. Headache  occiput/vertex
- maybe referred to mastoid
2. Postnasal discharge – Posterior rhinoscopy  pus
on roof and post. Wall of NP

41. • X-ray – Lateral view
• CT Scan

42. THANK YOU!