PARANASAL SINUSES Anatomy, Physiology and Diseases Maria Angelica M. Geronimo Group 5a
Feb 22, 2016
PARANASAL SINUSESAnatomy, Physiology and Diseases
Maria Angelica M. GeronimoGroup 5a
PARANASAL SINUSES
• Air-filled cavities that communicate with the nasal cavities
PARANASAL SINUSESAnatomy
Maxillary SinusFrontal Sinus
Anterior Ethmoid cells
Middle Meatus
NASAL CAVITY
Posterior Ethmoid cells
Superior Meatus
NASAL CAVITY
MAXILLARY SINUS
• Medial: nasal cavity• Floor: close to the root
of the second premolar and first molar teeth
• Posterior: Pterygopalatine fossa– Traversed by the
maxillary artery, branches of the CN V and ANS
ETHMOID AIR CELLS
• Labyrinthine system of small, pneumatized sinus cavities
• Posterior: close to CN II• Lamina papyracea – Orbital plate– Forms the lateral bony
wall that separates it from the orbit
SPHENOID SINUS• Center of the skull above
the nasopharynx• Clivus - forms the
posterior wall• Superior: sella turcica +
pituitary, and anterior and middle cranial fossae
• Lateral: cavernous sinus, ICA and CN II-VI
• Closely related to CN II
FRONTAL SINUS
• Floor: forms the medial portion of the orbital roof
• Anterior: anterior cranial fossa
PARANASAL SINUSESPhysiology
Functions
• Humidification• Vocal resonance• Mucus production• Increased olfactory area• Absorbs shock to the head• Regulation of intranasal pressure
PARANASAL SINUSESDiseases
Sinus Inflammation
Acute Chronic
MAXILLARY SINUSITISPredisposing factors Mild URTI
Nasal allergiesForeign bodiesDeviated nasal septum
Symptoms Fever, vague headache relieved by analgesics, malaiseFullness of the face, pain in the teeth esp. upon going up and down the stairsDull, throbbing cheek pain
Signs Tenderness to pressure and percussionFoul, mucopurulent secretionsDecreased transilluminationWater’s view- mucosal thickening and opacification of the maxillary sinuses
Organism Streptococcus pneumoniae, H. Influenzae, anaerobes, Branhamella Catarrhalis
Treatment Antibiotics, decogestants, analgesics
ETHMOID SINUSITISPrevalence Children: orbital cellulitis
Adults: accompanies maxillary sinusitis
Symptoms Pain and tenderness between the eyes and over the bridge of the noseThick nasal secretionsNasal obstruction
Treatment Antibiotics, nasal decongestants, analgesics, nasal sprays
FRONTAL SINUSITISPrevalence Associated with anterior ethmoditis
Predominantly in adults
Symptoms Pain is above the eyebrows usually in the AM, worse at midday, gradually lessens at the end of the dayForehead may be tender to touch and may have supra orbital swelling
Treatment Antibiotics, decongestants, vasoconstrictor nasal sprays
SPHENOID SINUSITISPrevalence Associated with other sinusitis
Not very common
Symptoms Headache directed to the vertex of the skull
Treatment Antibiotics, decongestants, vasoconstrictor nasal sprays
PARANASAL SINUSESComplications
Orbital Complications
Orbital Cellulitis
Abscess
Subperiosteal abscess
Orbital abscess
Cavernous Sinus Thrombosis
MUCOCOELE
• Mucus containing cyst found in the sinuses
• Frequently seen in the maxillary sinuses (mucus retention cysts)
• Ethmoids or frontal sinuses: swelling in the forehead
• Sphenoids sinus: diplopia or impaired vision
PYOCOELE
• Similar to a mucocoele but contains pus• Treatment: surgical removal and re-
establishment of a good drainage
ACUTE MENINGITIS
• Infections may spread through venous channels or directly from neighboring sinuses such as posterior wall of the frontal sinus
• Fever, chills, nausea, vomiting, signs of meningeal irritation
DURAL ABSCESS
• Collection of pus between dura and internal table of the skull usually seen in frontal sinusitis
• Intractable headache, spiking fever, may have signs of meningeal irritation
• Increased ICP
BRAIN ABSCESS
• Occurs through directly extending thrombophlebitis
• Brain may be contaminated at the peak of a severe suppurative sinusitis
• Chills and fever, lack of appetite, weight loss, nausea and vomiting
• Treatment: Massive IV antibiotics, surgical drainage
OSTEOMYELITIS
• Commonly seen in frontal sinusitis• Erosion of the frontal bone• Localized forehead pain, fever, chills, swelling
over brow area• Radiographs: “moth-eaten” appearance of the
margins of the sinuses