ALLERGIC RHINITIS ALLERGIC RHINITIS Definition Definition : IgE mediated hypersensitivity of : IgE mediated hypersensitivity of the mucous membrane of the nose upon exposure the mucous membrane of the nose upon exposure to antigenic substance. to antigenic substance. Incidence Incidence : common, 10-20% of population. : common, 10-20% of population. Types Types : 1. seasonal 2. perennial 3.perennial : 1. seasonal 2. perennial 3.perennial with seasonal exacerbation. with seasonal exacerbation. Etiology Etiology : : Predisposing factors Predisposing factors : : 1. Genetic predisposition: 50% of cases occur 1. Genetic predisposition: 50% of cases occur in atopic patient (atopy: tendency to develop in atopic patient (atopy: tendency to develop an exaggerated Ig E antibody response). an exaggerated Ig E antibody response). 2. Temperature changes. 2. Temperature changes. 3. psychgenic. 3. psychgenic.
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ALLERGIC RHINITISALLERGIC RHINITISDefinitionDefinition: IgE mediated hypersensitivity of the mucous : IgE mediated hypersensitivity of the mucous
membrane of the nose upon exposure to antigenic membrane of the nose upon exposure to antigenic substance.substance.
IncidenceIncidence: common, 10-20% of population.: common, 10-20% of population.
TypesTypes: 1. seasonal 2. perennial 3.perennial with seasonal : 1. seasonal 2. perennial 3.perennial with seasonal exacerbation.exacerbation.
EtiologyEtiology: :
Predisposing factorsPredisposing factors::
1. Genetic predisposition: 50% of cases occur in atopic 1. Genetic predisposition: 50% of cases occur in atopic patient (atopy: tendency to develop an exaggerated Ig E patient (atopy: tendency to develop an exaggerated Ig E antibody response).antibody response).
5.5. Contactant: e.g face powder.Contactant: e.g face powder.
PathogenesisPathogenesis::1.1. 11stst exposure exposure: : formation of IgE antibodies formation of IgE antibodies
which bind to specific sites on surface of which bind to specific sites on surface of mast cells.mast cells.
2.2. 2nd exposure2nd exposure:: +Ag-Ab reaction on +Ag-Ab reaction on surfaces of must cells with degranulation surfaces of must cells with degranulation of cells & release of chemical mediators: of cells & release of chemical mediators: e.g histamine, bradykinine, serotonine e.g histamine, bradykinine, serotonine resolution in local inflammatory reaction:resolution in local inflammatory reaction:
- Reduction of size of turbinate.- Reduction of size of turbinate.
- Nasal polypectomy- Nasal polypectomy
Vasomotor rhinitisVasomotor rhinitisIt is also called intrinsic rhinitis or non allergic perennial rhinitis. It may be It is also called intrinsic rhinitis or non allergic perennial rhinitis. It may be
related to drugs ( e.g. antihypertensive and contraceptive) or hormonal related to drugs ( e.g. antihypertensive and contraceptive) or hormonal
imbalance at menopause.imbalance at menopause.
Clinical pictureClinical picture::
1.1. Nasal obstruction and watery nasal discharge, which is often precipitated Nasal obstruction and watery nasal discharge, which is often precipitated
by temperature changes, and dusty atmosphere.by temperature changes, and dusty atmosphere.
2.2. Examination; shows swollen, edematous turbinates, with excessive Examination; shows swollen, edematous turbinates, with excessive
mucoid ecretios.mucoid ecretios.
Treatment :Treatment :
It is often unsatisfactory.It is often unsatisfactory.
1.1. Topical steroids may be beneficial.Topical steroids may be beneficial.
2.2. If the turbinates are markedly swollen we may do submucous dithermy or If the turbinates are markedly swollen we may do submucous dithermy or
submucosal injection of long acting steroids (vidion N1). submucosal injection of long acting steroids (vidion N1).
Nasal polypsNasal polypsDefinitionDefinition: :
Projections of edematous. Pedunculated mucosa of the nose and/or Projections of edematous. Pedunculated mucosa of the nose and/or Paranasal sinuses.Paranasal sinuses.
Etiology:Etiology: 1. Allergy: 1. Allergy: * Most accepted cause.* Most accepted cause. * 90% of polyps → oesinophilia.* 90% of polyps → oesinophilia. * Allergic rhinitis, Usually present.* Allergic rhinitis, Usually present. * 20-40% → bronchial asthma.* 20-40% → bronchial asthma. 2. Inflammatory, chronic sinusitis. 2. Inflammatory, chronic sinusitis.
Etiology:Etiology:Inflammatory or retention cyst:Inflammatory or retention cyst:Arise from mucosa of maxillary Arise from mucosa of maxillary antrum antrum →→ directed posteriorly. directed posteriorly.After passage through sinus ostium After passage through sinus ostium →→ directed towards the choana directed towards the choana →→ nasopharynx. nasopharynx.
IncidenceIncidence::- Common.Common.- Age: adult.Age: adult.If occurs in a child 2-10yrs → cystic fibrosis, should be If occurs in a child 2-10yrs → cystic fibrosis, should be suspected. There are extensive nasal plyps leading to suspected. There are extensive nasal plyps leading to broadening of the nasal bridge due to distention before broadening of the nasal bridge due to distention before fusion of the nasal bones. There is very thick and fusion of the nasal bones. There is very thick and tenacious nasal discharge (Mucoviscidosis). Sweat test tenacious nasal discharge (Mucoviscidosis). Sweat test (sodium level) is diagnostic. It has a very high rate of (sodium level) is diagnostic. It has a very high rate of recurrence.recurrence.
- Sex: equal.- Sex: equal.
- Uncommon.Uncommon.- Age: young adult.Age: young adult.
- Sex: equalSex: equal
Symptoms:Symptoms:Allergic:Allergic:-Bilateral gradual nasal obstruction.Bilateral gradual nasal obstruction.-Manifestation of allergic rhinitis.Manifestation of allergic rhinitis.
Inflammatory:Inflammatory:-PND: thick and purulent.PND: thick and purulent.-Unilateral or bilateral nasal obstruction and Unilateral or bilateral nasal obstruction and discharge.discharge.-Sinus headache.Sinus headache.
- Accumulated nasal - Accumulated nasal discharge in the obstructed discharge in the obstructed side.side.
Signs:Signs:Allergic:Allergic:-Bilateral, multiple, pale, glistening pedunculated Bilateral, multiple, pale, glistening pedunculated masses (grap-like growth) that fill the nasal bridge masses (grap-like growth) that fill the nasal bridge in long standing cases (Hypertolirism).in long standing cases (Hypertolirism).-Manifestations of allergic rhinitis.Manifestations of allergic rhinitis.
Inflammatory:Inflammatory:-Polyps: usually few pink, soft and arising mainly Polyps: usually few pink, soft and arising mainly from the middle meatus.from the middle meatus.-Purulent discharge: mainly from the middle Purulent discharge: mainly from the middle meatus. meatus.
Posterior rhinoscopy:Posterior rhinoscopy:Single polyp appears in the Single polyp appears in the nasopharynx.nasopharynx.
Investigations:Investigations:1.1. Culture and sensitivity.Culture and sensitivity.2.2. Allergic skin test.Allergic skin test.3.3. CT scan nose & paranasal sinuses.CT scan nose & paranasal sinuses.4.4. Biopsy from the ploys (macrophages or Biopsy from the ploys (macrophages or
Treatment:Treatment:Allergic:Allergic: 1. 1. MedicalMedical → small early polyps. → small early polyps. * Systemic steroids.* Systemic steroids.
* Topical steroids.* Topical steroids.* Antibiotics ê 2ry infection.* Antibiotics ê 2ry infection.* Anti allergic treatment.* Anti allergic treatment.
2. 2. Surgery:Surgery:* Simple polypectomy.* Simple polypectomy.* Intranasal ethmoidectomy (endoscopic or * Intranasal ethmoidectomy (endoscopic or microscopic).microscopic).
- Preoperative & postoperative steroids should be given.- Preoperative & postoperative steroids should be given. - There is high rate recurrence 40% after surgery - There is high rate recurrence 40% after surgery
2. 2. SurgicalSurgical: Transnasal endoscopic sinus surgery : Transnasal endoscopic sinus surgery (FESS).(FESS).
Endoscopic removal of nasal, Endoscopic removal of nasal, nasopharyngeal, and sinus parts nasopharyngeal, and sinus parts through a wide middle meatal through a wide middle meatal antrostomy.antrostomy.N.B: N.B: in recurrent cases → radical in recurrent cases → radical antrum operation was done.antrum operation was done.
N.B:N.B: Differential diagnosis of unilateral Differential diagnosis of unilateral nasal mass:nasal mass: 1. Benign neoplasm especially 1. Benign neoplasm especially inverted, firm papillary polyps. inverted, firm papillary polyps. 2. Malignant neoplasm: unilateral, 2. Malignant neoplasm: unilateral, bad odor, soft, bleeding on touch bad odor, soft, bleeding on touch mass.mass. 3. Meningocele and 3. Meningocele and encephalocoele: soft, pulsating, encephalocoele: soft, pulsating, reddish, polyp with superior reddish, polyp with superior attachment to skull base.attachment to skull base.
• It is contained within the body of maxilla.It is contained within the body of maxilla.
• Development begins in the 3Development begins in the 3rdrd fetal month. fetal month.
• Pneumatization starts at bieth, growth continues to 18 years of age.Pneumatization starts at bieth, growth continues to 18 years of age.
•Boundaries:Boundaries:• Anteriorly: cheek. Anteriorly: cheek. • Posteriorly: pterygopalaine fossa.Posteriorly: pterygopalaine fossa.• Roof: floor or orbit.Roof: floor or orbit.• Floor: palatine and alveolar process of maxilla.Floor: palatine and alveolar process of maxilla.• Medially: lateral nasal wall.Medially: lateral nasal wall.Level of floor of sinus varies with that of nasal floor, before age of 9 years Level of floor of sinus varies with that of nasal floor, before age of 9 years
sinus floor is at higher level, after the age of 9 years sinus floor is at lower sinus floor is at higher level, after the age of 9 years sinus floor is at lower level. level.
Maxillary sinus ostiumMaxillary sinus ostium::It is made by confluence of maxillary sinus mucosa and nasal mucosa. On It is made by confluence of maxillary sinus mucosa and nasal mucosa. On looking to the maxillary ostium from inside the sinus it will appear like an ellipse looking to the maxillary ostium from inside the sinus it will appear like an ellipse just below the junction of roof and medial wall half way between anterior and just below the junction of roof and medial wall half way between anterior and posterior walls.posterior walls.
Frontal sinus:Frontal sinus:• It is present between outer and inner tables of frontal bone.It is present between outer and inner tables of frontal bone.• it begins development after birth.it begins development after birth.• The two frontal sinuses may be of unequal size.The two frontal sinuses may be of unequal size.• The frontal sinus ostium lies in the most dependent area of the sinus.The frontal sinus ostium lies in the most dependent area of the sinus.• Frontal recess, is the space where frontal sinus opens.Frontal recess, is the space where frontal sinus opens.• The frontal sinus ostium and recess look an hour glass.The frontal sinus ostium and recess look an hour glass.
Ethmoid sinuses:Ethmoid sinuses:• The ethmoid bone is divided into:The ethmoid bone is divided into:
• Two ethmoid labyrinth which form ethmoid sinuses on both sides.Two ethmoid labyrinth which form ethmoid sinuses on both sides.
• Cribiform plate of ethmoid which separates the nose from anterior Cribiform plate of ethmoid which separates the nose from anterior cranical fossa.cranical fossa.
• Perpendicular plate of ethmoid which forms part of nasal septum.Perpendicular plate of ethmoid which forms part of nasal septum.• The ethmoid sinus consists of 7-17 small air cells.The ethmoid sinus consists of 7-17 small air cells.• It is divided into anterior group and posterior group by basal lamella It is divided into anterior group and posterior group by basal lamella
(oblique part of middle turbinate).(oblique part of middle turbinate).
Sphenoid sinus:Sphenoid sinus:• It is lies within the sphenoid bone.It is lies within the sphenoid bone.• Pneumatization of sinus begins in the 3Pneumatization of sinus begins in the 3rdrd year. year.• The ostium lies high in the anterior wall and opens in the Spheno The ostium lies high in the anterior wall and opens in the Spheno
Physiology of the paranasal Physiology of the paranasal sinusessinuses
Functions of the paranasal sinuses:Functions of the paranasal sinuses:1. Helps in resonating the voice.1. Helps in resonating the voice.
2. Lightens the weight of the skull.2. Lightens the weight of the skull.
3. Shock absoirption in trauma to the face or skull.3. Shock absoirption in trauma to the face or skull.
4. Assists in humidification and moistening the nasal cavity.4. Assists in humidification and moistening the nasal cavity.
Osteomeatal complex:Osteomeatal complex:Describe the area in which the frontal, maxillary & ethmoidal sinuses Describe the area in which the frontal, maxillary & ethmoidal sinuses drain. It is bounded by middle turbinate medially, lamina papyracea drain. It is bounded by middle turbinate medially, lamina papyracea laterally and basal lamella posteriorly and superiorly. Any mucosal laterally and basal lamella posteriorly and superiorly. Any mucosal thckcning or anatomical abnormality will affect these sinuses.thckcning or anatomical abnormality will affect these sinuses.
Mucociliary clearness:Mucociliary clearness:• The secretions of goblet cells & seromucinous glands form a mucous The secretions of goblet cells & seromucinous glands form a mucous
layer “mucous blanket” above the epithelium.layer “mucous blanket” above the epithelium.• Cilia carry this blanket towards the ostium of the sinus Cilia carry this blanket towards the ostium of the sinus →→ nose nose →→
Definition:Definition:Acute inflammation of the mucous Acute inflammation of the mucous membrane lining the paranasal sinuses. membrane lining the paranasal sinuses. One or more may be involved.One or more may be involved.Usually rhniosinustis.Usually rhniosinustis.
Chronic inflammation of the mucous Chronic inflammation of the mucous membrane lining of the paranasal membrane lining of the paranasal sinuses with irreversible pathological sinuses with irreversible pathological changes. changes.
Etiology:Etiology:Exciting causes:Exciting causes:A) NasalA) Nasal Acute rhinitis; commonest cause.Acute rhinitis; commonest cause. Viral exanthemata.Viral exanthemata. Neglected F.B.Neglected F.B. Nasal packing.Nasal packing.B) DentalB) Dental Dental infection.Dental infection. Extraction of 2Extraction of 2ndnd premolar or 1 premolar or 1stst molar. molar.C) ExternalC) External Compound facial fracture.Compound facial fracture. Penetrating F.B. e.g. gunshot.Penetrating F.B. e.g. gunshot.Predisposing factors:Predisposing factors:A) Local: any nasal disease obstructing the A) Local: any nasal disease obstructing the sinus ostium e.g. D.S, nasal polyps.sinus ostium e.g. D.S, nasal polyps.B) General: low general resistance.B) General: low general resistance.Organism: Streptococcus pneumonia, Organism: Streptococcus pneumonia, haemophilus influenza & Anaerobes (dental haemophilus influenza & Anaerobes (dental origin). origin).
1) Repeated acute attacks with 1) Repeated acute attacks with incomplete resolution:incomplete resolution:
A.A. Persistent of predisposing factors Persistent of predisposing factors persistent obstruction of the persistent obstruction of the osteomeatal complex.osteomeatal complex.
B.B. Inadequate treatment with residual Inadequate treatment with residual infection.infection.
2) High virulence of organism.2) High virulence of organism.
3) Low body resistance. 3) Low body resistance.
Pathology:Pathology:
Congestion & oedema of sinus mucosa Congestion & oedema of sinus mucosa occlusion of sinus ostium occlusion of sinus ostium impairment of sinus drainage & impairment of sinus drainage & mucociliary clearance mucociliary clearance accumulation accumulation of secretions inside the sinus of secretions inside the sinus stasis & stasis & infection with infection with pus formation. pus formation.
1. Mucosa: congested, edematous with 1. Mucosa: congested, edematous with fibrosis.fibrosis.
2. Cilia: degeneration with loss of ciliary 2. Cilia: degeneration with loss of ciliary function.function.
3. Late cases: the mucosa is either atrophic 3. Late cases: the mucosa is either atrophic or hypertrophic “irreversible pathology”.or hypertrophic “irreversible pathology”.
Symptoms:Symptoms:
A) General: fever, history of acute A) General: fever, history of acute rhinitis.rhinitis.
B) Local:B) Local:
1- Nasal obstruction: unilateral or 1- Nasal obstruction: unilateral or bilateral.bilateral.
2- Nasal discharge:2- Nasal discharge:-Unilateral or bilateral.Unilateral or bilateral.-Mucopurulent or purulent.Mucopurulent or purulent.-Postnasal drip Postnasal drip irritative cough. irritative cough.
A) General: manifestations of septic focus, A) General: manifestations of septic focus, history of repeated acute attacks.history of repeated acute attacks.
5- Symptoms of descending infections:5- Symptoms of descending infections:-Otitis media.Otitis media.-Recurrent pharyngitis.Recurrent pharyngitis.-Laryngitis & bronchitis.Laryngitis & bronchitis.
6- Symptoms of complications. 6- Symptoms of complications.
-On the affect sinus.On the affect sinus.-Sever, throbbing.Sever, throbbing.Coughing, bending forwards.Coughing, bending forwards.-Vacuum headache Vacuum headache frontal sinus ostium frontal sinus ostium obstruction with absorption of air obstruction with absorption of air periodic pain & headache.periodic pain & headache.5- Facial edema & swelling.5- Facial edema & swelling.6- Symptoms of complications.6- Symptoms of complications.
Signs:Signs:A) General: fever: higher in children.A) General: fever: higher in children.B) Local:B) Local:1- Tenderness over the affected sinus on 1- Tenderness over the affected sinus on deep pressure.deep pressure.2- Anterior rhinoscopy:2- Anterior rhinoscopy:•Mucosa: edematous & congested.Mucosa: edematous & congested.•Nasal discharge: middle meatus Nasal discharge: middle meatus anterior group.anterior group.3- Posterior rhinoscopy:3- Posterior rhinoscopy:•Nasal discharge:Nasal discharge:- Superior meatus - Superior meatus posterior group. posterior group.- Spheno ethmoidal recess - Spheno ethmoidal recess sphenoid. sphenoid.
Local:Local:1. 1. 2.2.3.3.
Sites of sins pain & tenderness in acute & Sites of sins pain & tenderness in acute & chronic sinusitis.chronic sinusitis.Maxillary: pain & tenderness over Maxillary: pain & tenderness over affected sinus.affected sinus.Ethmoidal:Ethmoidal:Pain Pain in between eyes. in between eyes.Tenderness Tenderness inner canthus. inner canthus.Frontal:Frontal:Pain Pain supra orbital & across supra orbital & across forehead.forehead.Tenderness Tenderness above eyebrow. Floor above eyebrow. Floor of sinus.of sinus.Sphenoid: pain Sphenoid: pain occipital. occipital.
Investigations:Investigations:1)1) Laboratory: C. & S. from nasal discharge.Laboratory: C. & S. from nasal discharge.2)2) Nasal endoscopy: ostium visualization, pus in different areas, anatomical Nasal endoscopy: ostium visualization, pus in different areas, anatomical
variations.variations.3)3) Radiological:Radiological: * X-ray sinus view: mucosal thickening, fluid level.* X-ray sinus view: mucosal thickening, fluid level.* C.T scan nose & PNS: investigation of choice.* C.T scan nose & PNS: investigation of choice.
Treatment:Treatment:A) A) Medical:Medical: 1- 1- General:General: - Bed rest.- Bed rest. - Plenty of fluids.- Plenty of fluids.
- Antibiotics: for 10-- Antibiotics: for 10-14days.14days.
B) B) Surgical:Surgical: Indication:Indication: aiming to Surgical drainage. aiming to Surgical drainage. 1) Failed medical ttt.1) Failed medical ttt. 2) Complications: present or 2) Complications: present or threatening. threatening.
A) A) Medical:Medical: 1- 1- General:General: - Same.- Same. - Antibiotics: for 4weeks.- Antibiotics: for 4weeks. 2- 2- LocalLocal: - Same.: - Same.
- Control of local nasal - Control of local nasal Predisposing factors.Predisposing factors.
B) B) Surgical:Surgical: Indication:Indication: 1) Failed medical treatment (up to 4 1) Failed medical treatment (up to 4 weeks).weeks). 2) Presence of mechanical obstruction 2) Presence of mechanical obstruction in the nose.in the nose.
Procedure:Procedure: Nowadays;Nowadays; →→ drainage of the affected drainage of the affected sinus by functional endoscopic sinus sinus by functional endoscopic sinus surgery (FESS).surgery (FESS).
Sinusitis in childrenSinusitis in childrenAccidenceAccidence:: - Age: 5-8 yrs.- Age: 5-8 yrs.
- Site: maxillary & ethmoid (commonest).- Site: maxillary & ethmoid (commonest).Etiology:Etiology:Predisposing factors:Predisposing factors:- Ciliary disorders e.g. kartagnar’s syndrome (Bronchitis Dectrocar)Ciliary disorders e.g. kartagnar’s syndrome (Bronchitis Dectrocar)- Mucosal abnormality e.g. cystic fibrosis (Muwvisidrlin).Mucosal abnormality e.g. cystic fibrosis (Muwvisidrlin).- Source of infection: common e.g. URT infection & exanthemata.Source of infection: common e.g. URT infection & exanthemata.- Low immunity.Low immunity.OrganismOrganism: Strept. Pneumonia, H. influenza & moraxella catarrtalis.: Strept. Pneumonia, H. influenza & moraxella catarrtalis.Clinical picture:Clinical picture:Acute:Acute: as adult + high fever & complications are more especially as adult + high fever & complications are more especially
orbital.orbital.Chronic:Chronic: less facial pain & headache than adult, descending infection less facial pain & headache than adult, descending infection
& chronic irritative cough.& chronic irritative cough.TreatmentTreatment::(A) Medical:(A) Medical: as adult. as adult.(B) Surgical:(B) Surgical: - No improvement after medical treatment.- No improvement after medical treatment.
- Presence of complication. - Presence of complication.
Orbital complicationsOrbital complications The commonest complication. 75% of orbital infections are due to The commonest complication. 75% of orbital infections are due to sinusitis.sinusitis.
AetiologyAetiology:: more common to occurs more common to occurs in ethmoditisin ethmoditis especially in especially in children. Less common t occurs children. Less common t occurs in in ethmoditis especially in children. ethmoditis especially in children. Less common with maxillary sinus.Less common with maxillary sinus.
. Mild inflammatory or reactionary edema of the "Preseptal . Mild inflammatory or reactionary edema of the "Preseptal connective tissue" due to proximity of infection in the ethmoids connective tissue" due to proximity of infection in the ethmoids →→ venous obstruction.venous obstruction.
. Pus collection between the orbital periosteum & the lamina . Pus collection between the orbital periosteum & the lamina papyracea.papyracea.
.There is: .There is: - Severe pain- Severe pain - Mild Proptosis. - Mild Proptosis.
- Good general condition. - Mild limitation of eye movement.- Good general condition. - Mild limitation of eye movement.
- Chemosis. - Chemosis. - Diminution of vision (reversible). - Diminution of vision (reversible).
33- Orbital cellulitis- Orbital cellulitis::. Diffuse edema of the orbital contents & bacteria actively invaded . Diffuse edema of the orbital contents & bacteria actively invaded
the orbitalthe orbitalcontents but pus formation does not occur.contents but pus formation does not occur.. There is. There is:-Sever pain. :-Sever pain. -- ↑ ↑ Proptosis.Proptosis.
-Bad general condition -Bad general condition - - ↑↑ limitation of eye movement. limitation of eye movement. -Chemosis. -Chemosis. -Diminution if vision condition -Diminution if vision condition
(reversible). (reversible).
4-4- Orbital abscess "intraperoisteal“: Orbital abscess "intraperoisteal“:. Pus collection within the orbit. . Pus collection within the orbit. . There is:. There is:-Sever throbbing pain. -Sever throbbing pain. -Marked proptosis. -Marked proptosis. -Very bad general condition -Total ophthalmoplegia.-Very bad general condition -Total ophthalmoplegia.
-Chemosis -Chemosis -Diminution of vision -Diminution of vision (irreversible).(irreversible).
5-5- Cavernous sinus thrombosis: Cavernous sinus thrombosis:Due to thrombosis of the superior & inferior ophthalmic veins Due to thrombosis of the superior & inferior ophthalmic veins
33- Surgical treatment of sinusitis.- Surgical treatment of sinusitis.
Osteomylitis of skullOsteomylitis of skullOccurs in diploic bones Occurs in diploic bones →→ frontal & maxillary. frontal & maxillary.
AetiolologyAetiolology: Direct extension of infection to bones or due to thrombophilbitis : Direct extension of infection to bones or due to thrombophilbitis of diploic veins.of diploic veins.
Clinical picture:Clinical picture:-General: fever, toxemia.General: fever, toxemia.-Pain, Oedema & tenderness over Pain, Oedema & tenderness over forehead.forehead.-Frontal fluctuant swelling or fistula.Frontal fluctuant swelling or fistula.
-General: fever, toxemia.General: fever, toxemia.-Pain, Oedema, tenderness over Pain, Oedema, tenderness over cheek.cheek.-Subperiosteal abscess over canine Subperiosteal abscess over canine fossa or oroantral fistula.fossa or oroantral fistula.
TreatmentTreatment: Hospitalization.: Hospitalization.1. Massive antibiotics.1. Massive antibiotics.2. Surgical drainage of abscess.2. Surgical drainage of abscess.3. Treatment of sinusitis.3. Treatment of sinusitis.
Intracranial complicationsIntracranial complications1. Meningitis: the most common intracraninal complication.1. Meningitis: the most common intracraninal complication.
2. Extradural abscess: occurs with frontal sinusitis & 2. Extradural abscess: occurs with frontal sinusitis & osteomylitis. Both 1 & 2 are similar to that of chronic ear.osteomylitis. Both 1 & 2 are similar to that of chronic ear.
3. Bruin abscess : Similar to that of chronic ear, with 3. Bruin abscess : Similar to that of chronic ear, with personality changes as a localizing sign.personality changes as a localizing sign.
1- Dangerous area of the face (boil & septal abscess). Facial 1- Dangerous area of the face (boil & septal abscess). Facial veins veins → → ophthalmic vs. ophthalmic vs. →→ CS. CS.
NN..BB.. Cranial and intracranial complications often follow acute Cranial and intracranial complications often follow acute frontal sinusitisfrontal sinusitis..
DD. . Descending infectionDescending infection::1.1. Acute otitis mediaAcute otitis media..2.2. LaryngitisLaryngitis..3.3. PharyngitisPharyngitis..4.4. Bronchitis and asthmatic attacksBronchitis and asthmatic attacks..5.5. Gastro-intestinal troubles as anorexia Gastro-intestinal troubles as anorexia and dyspepsiaand dyspepsia..
EE. . GeneralGeneral::Symptoms of septic focus as arthritis and Symptoms of septic focus as arthritis and nephritis.nephritis.
FF. . MucocelMucocel
MucocelMucocelDefinitionDefinition::
an expansion of a sinus by accumulation of mucoid secretionan expansion of a sinus by accumulation of mucoid secretion..
InvestigationsInvestigations::11. . XX--ray sinus view ray sinus view →→ --OpacificationOpacification..
--Loss of scalloped appearance of the frontal sinusLoss of scalloped appearance of the frontal sinus..
22. . CT scanCT scan..
TreatmentTreatment::Surgery; evacuation of mucocel with adequate drainage to Surgery; evacuation of mucocel with adequate drainage to avoid recurrence.avoid recurrence.