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    Complication Complications of Sinusitis

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    Ivan Dario
    Complications of sinusitis can affect the paranasal sinuses or other body parts. Common complications include orbital cellulitis, osteomyelitis of the maxilla or frontal bone, and intracranial complications. Orbital cellulitis presents as eye swelling and follows a mild upper respiratory infection. Intracranial complications are more common in young people and may involve multiple cranial nerves. Treatment involves antibiotics, surgery to drain abscesses, and addressing the underlying sinus infection.

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    Complication Complications of Sinusitis

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    Ivan Dario
    29 views4 pages
    Complications of sinusitis can affect the paranasal sinuses or other body parts. Common complications include orbital cellulitis, osteomyelitis of the maxilla or frontal bone, and intracranial complications. Orbital cellulitis presents as eye swelling and follows a mild upper respiratory infection. Intracranial complications are more common in young people and may involve multiple cranial nerves. Treatment involves antibiotics, surgery to drain abscesses, and addressing the underlying sinus infection.

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    Complications of sinusitis can affect the paranasal sinuses or other body parts. Common complications include orbital cellulitis, osteomyelitis of the maxilla or frontal bone, and intracranial complications. Orbital cellulitis presents as eye swelling and follows a mild upper respiratory infection. Intracranial complications are more common in young people and may involve multiple cranial nerves. Treatment involves antibiotics, surgery to drain abscesses, and addressing the underlying sinus infection.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    29 views4 pages

    Complication Complications of Sinusitis

    Uploaded by

    Ivan Dario
    Complications of sinusitis can affect the paranasal sinuses or other body parts. Common complications include orbital cellulitis, osteomyelitis of the maxilla or frontal bone, and intracranial complications. Orbital cellulitis presents as eye swelling and follows a mild upper respiratory infection. Intracranial complications are more common in young people and may involve multiple cranial nerves. Treatment involves antibiotics, surgery to drain abscesses, and addressing the underlying sinus infection.

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    of 4

    Complication

    Complications of Sinusitis
    DEFINITION

    A complication of rhinosinusit sitis may be defined as any adverse progression of chronic or acute
    bacterial infection beyond thee pparanasal sinuses, or compromise in function of any
    an part of the body
    due to local or distant effects of the condition.

    CAUSES

    Dental infections
    Toxic shock syndrome
    Associated Diseases include Otitis media, Adenotonsillitis, Bronchiectasis.
    Only Chronic complications inc
    nclude Mucoceles and mucopyoceles.

    ORBITAL CELLULITIS

    Usually in young < 20 yrs


    Mild upper respiratory tract infe
    fection accompanied or followed by swelling around d the eye.
    5 STAGES :
    1. Preseptal Cellulitis
    2. Post septal cellulitis i.e.
    .e. orbital cellulitis without abscess
    3. Subperiosteal Abscess
    4. Orbital Abscess
    5. Cavernous sinus thromb mbosis
    According to CHANDLER’s C Classification of Orbital Involvement
    Inflammatory Oedema Orbit
    bital Cellulitis Subperiosteal Abscess Orbital Abscess
    Ab CST
    Third stage may present with V Visual problems.
    If optic nerve function compromomised then visual acuity and colour vision affected.
    At stage five (cavernous sinus thrombosis), as well as chemosis, periorbital oedema and Proptosis,
    there will be a progressive opthalmoplegia (lateral gaze may be affected first) and visual impairment
    (possibly resulting in total blindness).
    Trigeminal paresthesias and headache may follow
    Often bilateral especially Proptosis
    Visual loss may be irreversible if retinal ischemic time exceeds 100 minutes.
    OTHERS
    Fever
    SUPERIOR ORBITAL FISSURE SYNDROME Deep orbital pain + Frontal Headache + 3,4,6
    nerve paralysis
    ORBITAL APEX SYNDROME Superior Orbital Fissure syndrome + Involvement of Optic
    Nerve and/or maxillary division of trigeminal nerve.

    MUCOCELE (describe all separately)

    OSTEOMYELITIS :

    Osteomyelitis is infection of bone marrow and should he differentiated from osteitis which is
    infection of the compact bone. Osteomyelitis, following sinus infection, involves either the maxilla or
    the frontal bone.

    Osteomyelitis of the maxilla.

    It is more often seen in infants and children than adults because of the presence of spongy bone in
    the anterior wall of the maxilla.
    Infection may start in the dental sac and then spread to the maxilla, but less often , it is primary
    infection of the maxillary sinus.
    Clinical features are erythema, swelling of cheek, oedema of lower lid, purulent nasal discharge and
    fever.
    Subperiosteal abscess followed by fistulae may form in infraorbital region, alveolus or palate, or in
    zygoma.
    Sequestration of bone may occur.
    Treatment consists of large doses of antibiotics, drainage of any abscess and removal of the
    sequestra.
    Osteomyelitis of maxilla may cause damage to temporary or permanent tooth-buds, maldevelopment
    of maxilla, oroantral fistula, persistently draining sinus or epiphora.
    Frontal Osteomylitis is k/a Potts puffy tumour.

    INTRACRANIAL COMPLICATIONS :

    Young affected more may be due to high vascularity of Diploeic system at this age.
    Other features of various complications (described separately)
    INVESTIGATIONS :

    In the case of orbital cellulitis, a formal assessment of the full range of eye movements, degree of
    proptosis, relative afferent pupillary defect, visual acuity (using a Snellen chart), colour vision (using
    Ishihara plates) and inspection of the optic disc should be made.
    For intracranial complications, clinical examination of the cranial nerves and central nervous system
    should be undertaken.

    Orbital complications Investigation of choice is a high definition computed tomography (CT)


    scan taken in both coronal and axial planes.
    Intracranial Complications MRI scanning has been demonstrated to be superior to CT in the
    diagnosis of intracranial complications and is the investigation of choice.
    Culture of any purulent material found in the nose

    TREATMENT

    MEDICAL

    Unless an abscess is demonstrated by radiological or other investigation, nonsurgical management of


    rhinosinusitis complications would usually be the first choice
    The exception to this would be when vision was affected by pressure on the optic nerve
    Antimicrobials (intravenous cephalosporin with metronidazole would be an appropriate first choice.)
    Decongestants
    Systemic steroid administration is sometimes recommended to accelerate the resolution of the
    inflammatory process BUT the immunosuppressive action of the steroids may mask other
    complications of the infective process.
    If there is not a significant clinical improvement in the first 24 hours of medical treatment, surgical
    intervention should be considered.
    For orbital complications, intravenous antibiotic administration should continue until clinical
    improvement is well established and only then should oral treatment be substituted.
    With intracranial complications, a prolonged (four- to eight-week) course of intravenous antibiotics
    may be necessary.

    SURGICAL

    For rhinosinusitis proper


    For complications
    Contraindications for an endoscopic approach include any intracranial complication, osteomyelitis
    of the frontal bone or orbital complications with an acute visual problem.

    ORBITAL CELLULITIS

    Infections with cellulitis alone are likely to settle with conservative treatment, whereas patients with
    proptosis but normal eye movements and visual acuity are likely to require surgery
    Some surgeons suggest that endoscopic ethmoidectomy together with removal of the lamina
    papyracea and perinasal drainage of the orbital abscess is sufficient treatment.
    However, unless the surgeon is extremely familiar with endoscopic nasal surgery, it is probably
    easier and wiser to use an external approach.
    If an external approach is used, the conventional Lynch-Howarth approach for an external
    ethmoidectomy will allow the surgeon to drain the subperiosteal abscess 'on the way' to carrying out
    the definitive Ethmoidectomy

    INTRACRANIAL COMPLICATIONS

    The surgical treatment of intracranial complications will inevitably involve neurosurgical expertise.
    It is probably better to undertake the surgery for the complication at the same time as undertaking
    surgical treatment for the underlying rhinosinusitis.

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