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Complications of sinusitis (Orbital complications (85%) (Cavernous sinus…
Complications of sinusitis
Sinusitis - Inflammation of one sinus
Pansinusitis - Inflammation of all sinuses
frontal or sphenoid sinus (adult)
ethmoid sinus (children)
Ethiology = bacteria
Streptococcus pneumoniae (No 1 adult) in adults the infection is usually mixed
Hemophilus influanzae (No 1 children)
Streptococcus pyogenes
Staphylococcus aureus
Orbital complications (85%)
Preseptal cellulitis (eyelids oedema)
Most common (children)
Pathomechanism
acute anterior ethmoiditis
ethmoid veins compression
serous inflammations of subcutaneous tissue
Symptoms
erythema and edema of the eyelid
NO decreased visual acuity and eyeballs motility
Possible sequences
eyelid abscess
Treatment
hospitalizations !!
antibiotics (I.V.)
nasal decongestans
Subperiosteal abscess
Pathomechanism:
a collection of pus between the periorbit and the bony orbit walls
ethmoid sinus (children); frontal sinus (adult)
Symptoms
paintfull erythema and edema of the eyelid
proptosis
impaired edeyeballs motility
NO impaired visual acuity
Possible sequences
eyelid abscess
orbital phlegmone/abscess
intracranial complications
Treatment
radical operation of affected sinus
abscess dreinage
antibiotics (I.V.)
nasal decongestans
Orbital cellulitis /phlegmone
Pathomechanism
penetration of subperiosteal abscess throught periorbit
throbophlebitis
Symptoms
eyeball: proptosis, ophthalmoplegia
eyelid: paintfull erythema and edema
decreased visual acuity
Possible sequences
blindness
intracranial complications
Treatment
radical operation of affected sinus
abscess dreinage
antibiotics (I.V.)
nasal decongestans
Retrobulbar optic neuritis
Pathomechanism
chronic posterior ethmoiditis or sphenoid sinusitis
compression by inflammatory inflitration (orbital apex syndrom)
throbophlebitis in the optic nerve vessels
Symptoms
central blind spot (onset); blurred vision
decreased visual acuity
Possible sequences
blindness
Treatment
conservative: antibiotics (I.V.); nasal decongestans
surgical: radical operation of affected sinus
Differentiation of orbital complications *
Cavernous sinus throbophlebitis
Symptoms
headache
photophobia
decreased visual acuity
facial analgesia (nn. V1 V2)
ophtalmoplegia (nn. III,IV,VI)
edema of eyelids and proptosis
conjuctivital chemosis
enlarged veins of orbital and frontal region
swelling of mastoid emissary vein region
septic fever with chills
sign of meningeal irritation
Possible sequences
permament decreased visual acuity or blindness (50%)
cranial nerves palsies (III, IV, VI)
lethal course (15-30%)
Treatment
antibiotics (I.V.)
sinus surgery - if allows general state
Frontal osteomyelitis (osteitis)
Pathomechanism
retrograde throbophlebitis (diploe veins - Brechet`s vein)
direct (throught continuity via erosion or through existing fractures or dehiscences
Symptoms
subacute (most common)
swelling of the forehead „Pott's puffy tumor”
headache
low grade fever
increased ESR, leukocytosis
X-ray changes
acute
severe headache
Possible sequences
intracranial complications (superior sagittal sinus throbosis and others CNS complications)
letal course (in acute frontal osteomyelitis on 7-10 day)
Treatment
radical operation of sinus
debridement of frontal bone involved by the osteomyelitis
antibiotics (I.V.)
Intracranial complications
Connections between sinuses and cranial cavity througt veins:
orbital veins (ophtalmic veins)
frontal diploe vein
emissary vein (fronto-ethmoid vein of de Sabatier-Blaudin)
anterior ethmoid vein
accompanying veins of the olphactory nerves
Epidural abscess
Frontal ostemyelitis or frontal sinusitis
Between dura and bone
Symptoms: headache, fever
CT picture
Treatment
radical operation of sinus
abscess drainage
antibiotics (I.V.)
Subdural empyema
between dura mater and arachnoid
limited or diffusse
Symptoms
fever, stiff neck,neurological disorders (seizures, hemiparesis)
increased intracranial pressure signs
consciousness disorders; coma
increased ESR, leukocytosis
Treatment
radical operation of affected sinus, abscess drainage, antibiotics
Cerebral abscess
Frontal lobe
Symptoms: headache, personality changes
somnolence, seizures
increased intracranial pressure signs
CT picture
Treatment
radical operation of affected sinus, abscess drainage, antibiotics
Meningitis
frontal; ehtmoid; sphenoid sinusitis
Symptoms
sudden onset, headache
stiff neck, consciousness disorders
seizures
typical for bacterial infection changes in cerebrospinal fluid (lubar puncture)
Possible sequences
lethal course (20%)
Treatment
radical operation of affected sinus
antibiotics
Prevention of complications
Proper treatment of acute sinusitis
resumption of sinus ventilation and drainage
antibioticotherapy (sufficient duration)
Proper (surgical) treatment of chronic sinusitis
classical (open) surgery
functional endoscopic sinus surgery (FESS)
Matar