Chronic Sinusitis Brig Mirza Khizar Hameed Definition Inflammation
![](https://slidetodoc.com/presentation_image_h/a093ec89d428b749bd4e292c0d42352e/image-1.jpg)
![Chronic Sinusitis Brig Mirza Khizar Hameed Chronic Sinusitis Brig Mirza Khizar Hameed](http://slidetodoc.com/presentation_image_h/a093ec89d428b749bd4e292c0d42352e/image-2.jpg)
Chronic Sinusitis Brig Mirza Khizar Hameed
![Definition Inflammation of the Paranasal Sinuses lasting > 3 months Definition Inflammation of the Paranasal Sinuses lasting > 3 months](http://slidetodoc.com/presentation_image_h/a093ec89d428b749bd4e292c0d42352e/image-3.jpg)
Definition Inflammation of the Paranasal Sinuses lasting > 3 months
![Etiology Anatomical variations Deviated Nasal Septum Concha Bullosa Bulla Ethmoidalis Underlying diseases Cystic Fibrosis Etiology Anatomical variations Deviated Nasal Septum Concha Bullosa Bulla Ethmoidalis Underlying diseases Cystic Fibrosis](http://slidetodoc.com/presentation_image_h/a093ec89d428b749bd4e292c0d42352e/image-4.jpg)
Etiology Anatomical variations Deviated Nasal Septum Concha Bullosa Bulla Ethmoidalis Underlying diseases Cystic Fibrosis Ciliary Dyskinesia Immuno-deficiency Granulomatous diseases
![Microbiology Anaerobes Staphylococcus aureus Streptococcus H. Influenzae M. catarrhalis Microbiology Anaerobes Staphylococcus aureus Streptococcus H. Influenzae M. catarrhalis](http://slidetodoc.com/presentation_image_h/a093ec89d428b749bd4e292c0d42352e/image-5.jpg)
Microbiology Anaerobes Staphylococcus aureus Streptococcus H. Influenzae M. catarrhalis
![Pathophysiology Obstruction of Osteomeatal complex region Impaired mucociliary clearance ↓ Stagnation & pooling of Pathophysiology Obstruction of Osteomeatal complex region Impaired mucociliary clearance ↓ Stagnation & pooling of](http://slidetodoc.com/presentation_image_h/a093ec89d428b749bd4e292c0d42352e/image-6.jpg)
Pathophysiology Obstruction of Osteomeatal complex region Impaired mucociliary clearance ↓ Stagnation & pooling of secretions Infection Vicious cycle
![Symptoms Chronic nasal obstruction Purulent post nasal discharge Pain over sinuses/ Headache Halitosis Chronic Symptoms Chronic nasal obstruction Purulent post nasal discharge Pain over sinuses/ Headache Halitosis Chronic](http://slidetodoc.com/presentation_image_h/a093ec89d428b749bd4e292c0d42352e/image-7.jpg)
Symptoms Chronic nasal obstruction Purulent post nasal discharge Pain over sinuses/ Headache Halitosis Chronic cough
![Physical signs Purulent Nasal discharge Anatomical anomalies Transillumination ? Physical signs Purulent Nasal discharge Anatomical anomalies Transillumination ?](http://slidetodoc.com/presentation_image_h/a093ec89d428b749bd4e292c0d42352e/image-8.jpg)
Physical signs Purulent Nasal discharge Anatomical anomalies Transillumination ?
![Investigations X-ray PNS CT Scan PNS Proof puncture/ Sinus lavage Sinus aspirate/ Pus swab Investigations X-ray PNS CT Scan PNS Proof puncture/ Sinus lavage Sinus aspirate/ Pus swab](http://slidetodoc.com/presentation_image_h/a093ec89d428b749bd4e292c0d42352e/image-9.jpg)
Investigations X-ray PNS CT Scan PNS Proof puncture/ Sinus lavage Sinus aspirate/ Pus swab for C/S
![Treatment Antibiotics – Ciprofloxacin, Augmentin, Clarithromycin, Cefuroxime, Clindamycin, Metronidazole Decongestants Antihistamines Steroid Nasal Drops/ Treatment Antibiotics – Ciprofloxacin, Augmentin, Clarithromycin, Cefuroxime, Clindamycin, Metronidazole Decongestants Antihistamines Steroid Nasal Drops/](http://slidetodoc.com/presentation_image_h/a093ec89d428b749bd4e292c0d42352e/image-10.jpg)
Treatment Antibiotics – Ciprofloxacin, Augmentin, Clarithromycin, Cefuroxime, Clindamycin, Metronidazole Decongestants Antihistamines Steroid Nasal Drops/ Sprays Surgery- To provide drainage & ventilation
![Operative procedures on Sinuses Operative procedures on Sinuses](http://slidetodoc.com/presentation_image_h/a093ec89d428b749bd4e292c0d42352e/image-11.jpg)
Operative procedures on Sinuses
![Maxillary Sinusitis Antral Washout Inferior Meatal Antrostomy Caldwell-Luc’s Operation FESS Maxillary Sinusitis Antral Washout Inferior Meatal Antrostomy Caldwell-Luc’s Operation FESS](http://slidetodoc.com/presentation_image_h/a093ec89d428b749bd4e292c0d42352e/image-12.jpg)
Maxillary Sinusitis Antral Washout Inferior Meatal Antrostomy Caldwell-Luc’s Operation FESS
![1. Antral Washout Puncturing medial wall of sinus for pus aspiration and irrigation of 1. Antral Washout Puncturing medial wall of sinus for pus aspiration and irrigation of](http://slidetodoc.com/presentation_image_h/a093ec89d428b749bd4e292c0d42352e/image-13.jpg)
1. Antral Washout Puncturing medial wall of sinus for pus aspiration and irrigation of sinus Indications - Ch sinusitis refractory to treatment Contraindications - Age < 3 yrs - Hypoplastic maxilla with thick bony walls - Acute maxillary sinusitis untreated by antibiotics
![Tilley Lichwitz Trocar & Cannula Tilley Lichwitz Trocar & Cannula](http://slidetodoc.com/presentation_image_h/a093ec89d428b749bd4e292c0d42352e/image-14.jpg)
Tilley Lichwitz Trocar & Cannula
![Higginson Syringe Higginson Syringe](http://slidetodoc.com/presentation_image_h/a093ec89d428b749bd4e292c0d42352e/image-15.jpg)
Higginson Syringe
![Trocar directed towards I/L tragus Trocar directed towards I/L tragus](http://slidetodoc.com/presentation_image_h/a093ec89d428b749bd4e292c0d42352e/image-16.jpg)
Trocar directed towards I/L tragus
![Complications Hemorrhage Pain & swelling of cheek Perforation of orbital floor Vasovagal shock Air Complications Hemorrhage Pain & swelling of cheek Perforation of orbital floor Vasovagal shock Air](http://slidetodoc.com/presentation_image_h/a093ec89d428b749bd4e292c0d42352e/image-17.jpg)
Complications Hemorrhage Pain & swelling of cheek Perforation of orbital floor Vasovagal shock Air embolism
![2. Inferior Meatal Antrostomy A window is created in medial wall of Maxillary antrum 2. Inferior Meatal Antrostomy A window is created in medial wall of Maxillary antrum](http://slidetodoc.com/presentation_image_h/a093ec89d428b749bd4e292c0d42352e/image-18.jpg)
2. Inferior Meatal Antrostomy A window is created in medial wall of Maxillary antrum by perforating it in the Inferior meatus with Tilley’s Antrum Harpoon & enlarged (1. 5 -2 cm) with Myle’s perforator
![Complications Hemorrhage Injury to Naso-lacrimal duct Perforation of orbital floor Complications Hemorrhage Injury to Naso-lacrimal duct Perforation of orbital floor](http://slidetodoc.com/presentation_image_h/a093ec89d428b749bd4e292c0d42352e/image-19.jpg)
Complications Hemorrhage Injury to Naso-lacrimal duct Perforation of orbital floor
![3. Caldwell-Luc’s Surgery Anterior wall of the Maxillary sinus is entered through a Sub-labial 3. Caldwell-Luc’s Surgery Anterior wall of the Maxillary sinus is entered through a Sub-labial](http://slidetodoc.com/presentation_image_h/a093ec89d428b749bd4e292c0d42352e/image-20.jpg)
3. Caldwell-Luc’s Surgery Anterior wall of the Maxillary sinus is entered through a Sub-labial incision A window is created in the medial wall through Antrostomy Indications - Ch sinusitis refractory to treatment - Repair of Oro-antral fistula - Reccurrent AC polyp - Blow out fracture of floor of orbit - Approach to ethmoids/ PPF
![Sublabial Incision Sublabial Incision](http://slidetodoc.com/presentation_image_h/a093ec89d428b749bd4e292c0d42352e/image-21.jpg)
Sublabial Incision
![Hole made in anterior wall followed by Inferior Meatal Antrostomy Hole made in anterior wall followed by Inferior Meatal Antrostomy](http://slidetodoc.com/presentation_image_h/a093ec89d428b749bd4e292c0d42352e/image-22.jpg)
Hole made in anterior wall followed by Inferior Meatal Antrostomy
![Complications Hemorrhage Cheek edema Numbness of cheek Orbital hematoma Trauma to teeth roots Oro-antral Complications Hemorrhage Cheek edema Numbness of cheek Orbital hematoma Trauma to teeth roots Oro-antral](http://slidetodoc.com/presentation_image_h/a093ec89d428b749bd4e292c0d42352e/image-23.jpg)
Complications Hemorrhage Cheek edema Numbness of cheek Orbital hematoma Trauma to teeth roots Oro-antral fistula
![Ethmoid Sinusitis Intranasal Ethmoidectomy External Ethmoidectomy - Lynch Howarth procedure - Patterson transorbital procedure Ethmoid Sinusitis Intranasal Ethmoidectomy External Ethmoidectomy - Lynch Howarth procedure - Patterson transorbital procedure](http://slidetodoc.com/presentation_image_h/a093ec89d428b749bd4e292c0d42352e/image-24.jpg)
Ethmoid Sinusitis Intranasal Ethmoidectomy External Ethmoidectomy - Lynch Howarth procedure - Patterson transorbital procedure - Jansen Horgan transantral procedure FESS
![Lynch Howarth Ethmoidectomy Lynch Howarth Ethmoidectomy](http://slidetodoc.com/presentation_image_h/a093ec89d428b749bd4e292c0d42352e/image-25.jpg)
Lynch Howarth Ethmoidectomy
![Patterson Ethmoidectomy Patterson Ethmoidectomy](http://slidetodoc.com/presentation_image_h/a093ec89d428b749bd4e292c0d42352e/image-26.jpg)
Patterson Ethmoidectomy
![Trans-antral ethmoidectomy Trans-antral ethmoidectomy](http://slidetodoc.com/presentation_image_h/a093ec89d428b749bd4e292c0d42352e/image-27.jpg)
Trans-antral ethmoidectomy
![Complications Hemorrhage Injury to Lamina papyracea Periorbital hematoma, proptosis, visual loss Injury to Medial Complications Hemorrhage Injury to Lamina papyracea Periorbital hematoma, proptosis, visual loss Injury to Medial](http://slidetodoc.com/presentation_image_h/a093ec89d428b749bd4e292c0d42352e/image-28.jpg)
Complications Hemorrhage Injury to Lamina papyracea Periorbital hematoma, proptosis, visual loss Injury to Medial palpebral ligament CSF leak Meningitis Mucocoele formation
![Frontal Sinusitis Trephination Osteoplastic flap procedure - Coronal incision - Brow incision FESS Frontal Sinusitis Trephination Osteoplastic flap procedure - Coronal incision - Brow incision FESS](http://slidetodoc.com/presentation_image_h/a093ec89d428b749bd4e292c0d42352e/image-29.jpg)
Frontal Sinusitis Trephination Osteoplastic flap procedure - Coronal incision - Brow incision FESS
![Frontal sinus trephination Frontal sinus trephination](http://slidetodoc.com/presentation_image_h/a093ec89d428b749bd4e292c0d42352e/image-30.jpg)
Frontal sinus trephination
![Osteoplastic flap procedure Osteoplastic flap procedure](http://slidetodoc.com/presentation_image_h/a093ec89d428b749bd4e292c0d42352e/image-31.jpg)
Osteoplastic flap procedure
![Complications Hematoma Frontal depression CSF leak Meningitis Mucocoele formation Osteomyelitis Complications Hematoma Frontal depression CSF leak Meningitis Mucocoele formation Osteomyelitis](http://slidetodoc.com/presentation_image_h/a093ec89d428b749bd4e292c0d42352e/image-32.jpg)
Complications Hematoma Frontal depression CSF leak Meningitis Mucocoele formation Osteomyelitis
![Sphenoid Sinusitis Trans-nasal trans-septal approach Sublabial trans-septal approach External ethmoidectomy approach FESS Sphenoid Sinusitis Trans-nasal trans-septal approach Sublabial trans-septal approach External ethmoidectomy approach FESS](http://slidetodoc.com/presentation_image_h/a093ec89d428b749bd4e292c0d42352e/image-33.jpg)
Sphenoid Sinusitis Trans-nasal trans-septal approach Sublabial trans-septal approach External ethmoidectomy approach FESS
![FESS Indications - Ch sinusitis refractory to treatment - Nasal polyps - Fungal sinusitis FESS Indications - Ch sinusitis refractory to treatment - Nasal polyps - Fungal sinusitis](http://slidetodoc.com/presentation_image_h/a093ec89d428b749bd4e292c0d42352e/image-34.jpg)
FESS Indications - Ch sinusitis refractory to treatment - Nasal polyps - Fungal sinusitis - Antro choanal polyp - Fronto-ethmoidal mucocoele - Repair of CSF leak - DCR - Orbital decompression
![Functional Endoscopic Sinus Surgery Uncinectomy (Infundibulotomy) Bullectomy & Anterior ethmoidectomy Middle meatal antrostomy Perforation Functional Endoscopic Sinus Surgery Uncinectomy (Infundibulotomy) Bullectomy & Anterior ethmoidectomy Middle meatal antrostomy Perforation](http://slidetodoc.com/presentation_image_h/a093ec89d428b749bd4e292c0d42352e/image-35.jpg)
Functional Endoscopic Sinus Surgery Uncinectomy (Infundibulotomy) Bullectomy & Anterior ethmoidectomy Middle meatal antrostomy Perforation of basal lamella Posterior ethmoidectomy Sphenoid sinus exploration Skull base disease clearance Frontal recess exploration
![Complications Major epistaxis Orbital hematoma Diplopia Blindness or visual acuity Internal carotid injury Intracranial Complications Major epistaxis Orbital hematoma Diplopia Blindness or visual acuity Internal carotid injury Intracranial](http://slidetodoc.com/presentation_image_h/a093ec89d428b749bd4e292c0d42352e/image-36.jpg)
Complications Major epistaxis Orbital hematoma Diplopia Blindness or visual acuity Internal carotid injury Intracranial hemorrhage CSF leak / Meningitis Pneumocephalus Anosmia Nasolacrimal duct trauma Minor © Minor epistaxis © Hyposmia © Adhesions (synechiae) © Headache © Periorbital echhymosis © Periorbital hematoma © Dental / facial pain
![Fungal Sinusitis Fungal Sinusitis](http://slidetodoc.com/presentation_image_h/a093ec89d428b749bd4e292c0d42352e/image-37.jpg)
Fungal Sinusitis
![Definition Inflammation of the sinuses due to a fungus Definition Inflammation of the sinuses due to a fungus](http://slidetodoc.com/presentation_image_h/a093ec89d428b749bd4e292c0d42352e/image-38.jpg)
Definition Inflammation of the sinuses due to a fungus
![Classification Non Invasive Fungal Sinusitis - Allergic - Fungus Ball (Mycetoma) Invasive Fungal Sinusitis Classification Non Invasive Fungal Sinusitis - Allergic - Fungus Ball (Mycetoma) Invasive Fungal Sinusitis](http://slidetodoc.com/presentation_image_h/a093ec89d428b749bd4e292c0d42352e/image-39.jpg)
Classification Non Invasive Fungal Sinusitis - Allergic - Fungus Ball (Mycetoma) Invasive Fungal Sinusitis - Acute - Chronic
![Allergic Fungal Sinusitis Most common form Warm humid climate Among younger, immuno-competent, atopic Hypersensitivity Allergic Fungal Sinusitis Most common form Warm humid climate Among younger, immuno-competent, atopic Hypersensitivity](http://slidetodoc.com/presentation_image_h/a093ec89d428b749bd4e292c0d42352e/image-40.jpg)
Allergic Fungal Sinusitis Most common form Warm humid climate Among younger, immuno-competent, atopic Hypersensitivity reaction to inhaled fungus organism Presents with Nasal polyps & thick greenish mucus
![Investigations Total Ig. E - CT Scan PNS- Sinus filled with high signal intensity Investigations Total Ig. E - CT Scan PNS- Sinus filled with high signal intensity](http://slidetodoc.com/presentation_image_h/a093ec89d428b749bd4e292c0d42352e/image-41.jpg)
Investigations Total Ig. E - CT Scan PNS- Sinus filled with high signal intensity soft tissue with calcium deposits, thinning/ pressure bony erosion & remodelling Histology of greasy mucous- branching, non invasive fungal hyphae, eosinophils & Charcot. Leyden crystals
![](http://slidetodoc.com/presentation_image_h/a093ec89d428b749bd4e292c0d42352e/image-42.jpg)
![](http://slidetodoc.com/presentation_image_h/a093ec89d428b749bd4e292c0d42352e/image-43.jpg)
![Treatment Surgical clearance of sinuses Topical Steroids Antihistamines Immunotherapy ? Antifungal Treatment Surgical clearance of sinuses Topical Steroids Antihistamines Immunotherapy ? Antifungal](http://slidetodoc.com/presentation_image_h/a093ec89d428b749bd4e292c0d42352e/image-44.jpg)
Treatment Surgical clearance of sinuses Topical Steroids Antihistamines Immunotherapy ? Antifungal
![Fungus Ball (Mycetoma) Older individuals, usually females Immunocompetent Asymptomatic/ Cacosmia/ Chronic sinusitis Fungal mass Fungus Ball (Mycetoma) Older individuals, usually females Immunocompetent Asymptomatic/ Cacosmia/ Chronic sinusitis Fungal mass](http://slidetodoc.com/presentation_image_h/a093ec89d428b749bd4e292c0d42352e/image-45.jpg)
Fungus Ball (Mycetoma) Older individuals, usually females Immunocompetent Asymptomatic/ Cacosmia/ Chronic sinusitis Fungal mass limited to one sinus CT Scan- Hyperdense mass with punctate calcifications
![](http://slidetodoc.com/presentation_image_h/a093ec89d428b749bd4e292c0d42352e/image-46.jpg)
![Fungus Ball- Treatment Surgical clearance ? Anti fungal Fungus Ball- Treatment Surgical clearance ? Anti fungal](http://slidetodoc.com/presentation_image_h/a093ec89d428b749bd4e292c0d42352e/image-47.jpg)
Fungus Ball- Treatment Surgical clearance ? Anti fungal
![Acute Invasive Fungal Sinusitis Most lethal form Immunocompromised/ Diabetics Caused by Mucorales, Aspergillus, Fusarium, Acute Invasive Fungal Sinusitis Most lethal form Immunocompromised/ Diabetics Caused by Mucorales, Aspergillus, Fusarium,](http://slidetodoc.com/presentation_image_h/a093ec89d428b749bd4e292c0d42352e/image-48.jpg)
Acute Invasive Fungal Sinusitis Most lethal form Immunocompromised/ Diabetics Caused by Mucorales, Aspergillus, Fusarium, Phaeohyphomycosis Angio invasion, hematogenous spread Local necrosis, orbital & intracranial spread Fever, pain, nasal congestion, epistaxis, proptosis, headaches, seizures
![](http://slidetodoc.com/presentation_image_h/a093ec89d428b749bd4e292c0d42352e/image-49.jpg)
![AIFS- CT Findings Unilateral nasal soft tissue thickening Bony erosions Unilateral involvement of PNS AIFS- CT Findings Unilateral nasal soft tissue thickening Bony erosions Unilateral involvement of PNS](http://slidetodoc.com/presentation_image_h/a093ec89d428b749bd4e292c0d42352e/image-50.jpg)
AIFS- CT Findings Unilateral nasal soft tissue thickening Bony erosions Unilateral involvement of PNS Proptosis Cavernous sinus thrombosis
![Acute Invasive Fungal Sinusitis - CT Unilateral ethmoid involvement with bone destruction, intraorbital spread Acute Invasive Fungal Sinusitis - CT Unilateral ethmoid involvement with bone destruction, intraorbital spread](http://slidetodoc.com/presentation_image_h/a093ec89d428b749bd4e292c0d42352e/image-51.jpg)
Acute Invasive Fungal Sinusitis - CT Unilateral ethmoid involvement with bone destruction, intraorbital spread and proptosis
![](http://slidetodoc.com/presentation_image_h/a093ec89d428b749bd4e292c0d42352e/image-52.jpg)
![AIFS- Treatment Aggressive surgical debridement Systemic anti fungal therapy Treatment of underlying cause of AIFS- Treatment Aggressive surgical debridement Systemic anti fungal therapy Treatment of underlying cause of](http://slidetodoc.com/presentation_image_h/a093ec89d428b749bd4e292c0d42352e/image-53.jpg)
AIFS- Treatment Aggressive surgical debridement Systemic anti fungal therapy Treatment of underlying cause of immunosuppression
![Chronic Invasive Fungal Sinusitis Immunocompetent with H/o Ch sinusitis Progressin over months to years Chronic Invasive Fungal Sinusitis Immunocompetent with H/o Ch sinusitis Progressin over months to years](http://slidetodoc.com/presentation_image_h/a093ec89d428b749bd4e292c0d42352e/image-54.jpg)
Chronic Invasive Fungal Sinusitis Immunocompetent with H/o Ch sinusitis Progressin over months to years Maxillofacial soft tissue swelling Orbital involvement proptosis, visual loss Intracranial extension with cranial neuropathies, headaches seizures CT Scan- Hyperdense mass, bone erosion
![](http://slidetodoc.com/presentation_image_h/a093ec89d428b749bd4e292c0d42352e/image-55.jpg)
![CIFS- Treatment Aggressive surgical exenteration Systemic anti fungal therapy CIFS- Treatment Aggressive surgical exenteration Systemic anti fungal therapy](http://slidetodoc.com/presentation_image_h/a093ec89d428b749bd4e292c0d42352e/image-56.jpg)
CIFS- Treatment Aggressive surgical exenteration Systemic anti fungal therapy
![Thank you Thank you](http://slidetodoc.com/presentation_image_h/a093ec89d428b749bd4e292c0d42352e/image-57.jpg)
Thank you
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