sinus exam

The sinus is also called the paranasal sinus and the paranasal sinus. A plurality of gas-bearing bone cavities around the nasal cavity. They are concealed in the nasal cavity, the maxillary sinus is located on both sides of the nasal cavity, in the maxilla above the eyelid; the frontal sinus is in the frontal bone; the ethmoid sinus is located on both sides of the upper part of the nasal cavity, consisting of many small gas chambers in the sieve; the sphenoid sinus is behind the nasal cavity Inside the cheekbones. They all communicate with the nasal cavity with a small opening. In addition to participating in the humid and warm inhaled air, the sinus also plays an important role in the shape of the human face, supporting the inside of the skull, and reducing the weight of the skull. There are many common sinus examination methods. Basic Information Specialist Category: Otolaryngology Examination Category: Endoscope Applicable gender: whether men and women apply fasting: not fasting Tips: Pay attention to the movements to be light and avoid rough operation. Normal value The normal nasal mucosa is light red, and the surface is smooth and moist; if the turbinate is lightly touched, the mucous membrane is soft and elastic, and no secretions accumulate in each nasal passage. The development, shape and size of the sinus cavity are normal. No polyps or new organisms in the nasal passages, no swelling or polypoid changes in the nasal mucosa. Clinical significance Abnormal results: X-ray manifestations of sinusitis mainly include: 1 the consistency of sinus cavity density is often the manifestation of acute sinusitis; 2 the annular dense shadow of different thickness around the sinus cavity shows the thickening of sinus mucosa; 3 sinus cavity A liquid level is a manifestation of empyema or hemorrhage. Sinus CT examination is a detailed examination of the lesions in the sinus and an imaging examination that is indispensable for the patient's anatomy before surgery. Nasal endoscopy: nasal endoscope with biopsy forceps, aspirator, photo and magnification device, divided into adult and child type, its characteristics can be seen inside the middle nasal passage, sinus opening and upper turbinate, etc. . The sinus endoscope can be placed directly into the sinus to observe the internal sinus. When the sinus has inflammation, the sinus mucosa can be seen as congestion and edema. The sinus ostium is blocked or the secretions are discharged from the sinus ostium. The operation can also be performed under the nasal endoscope. The mucosa is bright red and has a viscous secretion when it is acutely anterior. In chronic inflammation, the mucosa is dark red, the front of the inferior turbinate is sometimes mulberry-like, and the secretion is mucopurulent. The mucosa of allergic rhinitis is pale edema or lavender, and the secretion is watery. Atrophic rhinitis mucosa shrinks, dries, loses normal luster, is covered with purulent sputum, the lower turbinate shrinks, and the middle turbinate occasionally has hypertrophy or polypoid changes. The middle nasal passage is caused by sinus lesions in the anterior group of purulent secretions, and the purulent discharge in the olfactory sulcus is caused by sinus lesions in the posterior group. The normal markers of posterior nasal examination are unclear, the color of the mucosa is abnormal, the gland-like value increases or remains, and there are ulcers, new organisms and secretions. People who need to be examined: patients with sinusitis. Precautions Taboo before inspection: Pay attention to the movements to be light and avoid rough operation. Requirements for inspection: Actively cooperate with the doctor's work. Inspection process Commonly used sinus examination methods are: (1) Visual examination and palpation. (2) anterior and posterior endoscopy: mainly observe the presence or absence of pus and pus in the nasal passages to determine which group of sinuses is inflamed. In addition, it is necessary to pay attention to the presence or absence of polyps or new organisms in the nasal passages, and whether the nasal mucosa has swelling or polypoid changes. (3) Head position drainage method: Firstly, the pus is swabbed, and the middle nasal passage and the olfactory fissure mucosa are contracted with a 1% ephedrine saline film to help the sinus mouth open. Then, the subject is tilted to a certain position for about 15 minutes, so that the pus flows out, and then the nose and the back are examined to determine the source of the pus. Generally, if the maxillary sinus is suspected of empyema, take the supine head low position; if the frontal sinus or ethmoid sinus is suspected, take the sitting position; if the sphenoid sinus is found, the head should be lowered, and the forehead or nose should be placed down on the table. There is also a head low drainage method. (4) maxillary sinus puncture washing method: 1) anesthesia: generally use cotton swab 蘸 1% dicaine (with a little 0.1% adrenaline, can reduce bleeding during puncture) placed on the outer wall of the lower nasal passage, after 15 minutes puncture. (2) puncture: use the right hand to take the needle of the maxillary sinus needle, the end of the puncture needle handle is close to the palm muscle muscle, the needle is inclined to the nasal septum, placed in the lower nasal passage about 1cm from the front of the inferior turbinate, close to the lower nose The top of the road side. The medical practitioner fixed the patient's head with his left hand, and the right hand held the needle slightly to the direction of the external eye of the affected side. The lightly rotated and had the feeling of penetrating the bone wall into the cavity, and the needle entered the maxillary sinus. (3) Flushing: Pull out the needle core, connect the syringe or rubber tube to the joint, and take the patient's head low and breathe slowly. First check back for air or pus, then inject normal saline. If pus flows out of the nasal cavity, continue to rinse until the pus disappears, then inject anti-inflammatory drugs such as gentamicin and dexamethasone. After the rinsing is completed, the needle is pulled out, and the puncture site is pressed with a sterile cotton ball to stop bleeding. The pus extracted from the sinus can be used for bacteriology and pathology. (5) nasal transillumination method: This method is only used to check the frontal sinus and maxillary sinus, in the dark room. The transilluminator is a slender tube with a small bulb at one end. During the examination, the light is transmitted through the sinus wall, and the transmittance on both sides is compared to estimate whether there is any lesion in the sinus. (6) X-ray examination method: 1 nasal position: also known as Fahrenheit. The patient's nasal patch, the central ray is tilted 15° to the foot, and projected from the back to the front through the tip of the nose. Mainly used to check the maxillary sinus, but also the ethmoid sinus, frontal sinus, nasal cavity and eyelids. 2 nasal position or pillow position: also known as the Koch position. The patient's nasal patch, the central ray is tilted 15° to the foot, and is projected from the posterior and posterior through the nasal root. Mainly used to check the frontal sinus and ethmoid sinus, but also the maxillary sinus, nasal cavity and eyelids. From the X-ray, we can understand the development, shape and size of the sinus cavity, whether there is mucosal thickening, space-occupying lesions and bone wall destruction. If you want to observe the presence or absence of effusion in the sinus cavity, you should take a seat. 3 necessary fashion can be added to the lateral position (viewing the sinus, the sella and the nasopharynx from the side), optic nerve hole (observing the ethmoid sinus and sphenoid sinus, can also check the frontal sinus and sacral tip), the skull base (observing the sphenoid sinus , the posterior wall of the maxillary sinus, the skull base, the nasal cavity and the nasopharynx. (7) computed tomography (CT) can show the outline and extent of tumors or cysts in the nose and sinuses in detail, and determine whether the tumor invades the intracranial, intraorbital, pterygopalatine, etc.; skull base destruction The situation can also be clearly stated. For cases where the diagnosis of conventional X-ray examination techniques is not clear, the diagnosis rate can be further improved. Magnetic resonance imaging (MRI) can accurately determine the location, size and degree of invasion of the head and neck tumors such as the nose, sinus and nasopharynx, and can observe the anatomical relationship between the tumor and the surrounding soft tissue, blood vessels and lymph nodes, and even determine the tumor supply. Blood vessels, etc. Not suitable for the crowd Inappropriate crowd: None. Adverse reactions and risks No related complications and hazards have been found.