chronic sphenoid sinusitis
Introduction
Introduction to chronic sphenoid sinusitis In the past, sphenoid sinusitis was considered to be a rare nasal disease. According to Liu Junqian (1958), 660 cases of sinus X-ray films, only 6 cases of chronic sphenoid sinusitis alone, accounting for 0.9%, due to the deep position of the sphenoid sinus, lack of illumination of the nose. The condition of the opening is not seen, and the symptoms of sphenoid sinusitis are not clear, so the incidence of sphenoid sinusitis is considered to be the lowest. In recent years, due to the advent of cold light source nasal endoscopes, various angles of view can be utilized to improve the illumination and visibility throughout the nose, and the limitation of visual field is overcome, so the incidence of chronic sphenoid sinusitis is also significantly improved. According to Zhao Ruran and other data (1988), in 700 routine nasal endoscopy, 58 cases of sphenoid sinusitis, accounting for 8.3%. basic knowledge The proportion of illness: 15% Susceptible people: no specific population Mode of infection: non-infectious Complications: cerebrospinal fluid rhinorrhea
Cause
Causes of chronic sphenoid sinusitis
Same as chronic ethmoid sinusitis.
Prevention
Chronic sphenoid sinus prevention
1. Strengthen physical exercise, enhance physical fitness, and prevent colds.
2. Active rhinitis (cold) and toothache should be actively treated.
3. Do not force the nose when there is secretion in the nasal cavity. It should block one side of the nostril and clean the nasal secretions, and then block the other side of the nostrils to clean the nasal secretions.
4. Timely and thorough treatment of acute inflammation of the nasal cavity and correction of nasal deformity, treatment of chronic rhinitis.
Complication
Chronic sphenoid sinus complications Complications Cerebrospinal fluid rhinorrhea
Common surgical complications of the above-mentioned various sphenoid sinus surgery, if you follow the usual practice, there will be no complications. The key problem of surgical complications is not to clamp the diseased tissue in the sphenoid sinus, because the upper wall of the butterfly is the dura mater and brain. The pituitary gland and the sphenoid sinus wall are closely related to the optic nerve, the internal carotid artery, the cavernous sinus and the maxillary nerve. The neurovascular adheres to the cranial cavity of the sphenoid sinus wall, forming an impression on the bone wall and protruding into the sphenoid sinus cavity to form a bulge. Sometimes the bulge at the bulge is thin or even absent. If the wall lesions are clamped during surgery, it will have catastrophic consequences. According to Xu Wei, Wang Jiqun (1994) published 50 cases of measurement, the optic canal bulge accounted for bone wall defects. 2%, the internal carotid artery bulge bone wall defect accounted for 4%, the optic canal sinus wall at the top of the wall, from the back to the front, the internal carotid artery tube is located below the optic canal, from the front to the back and below the curve, surgery The most vulnerable, the wing tube is on the outside of the inferior wall of the sphenoid sinus, and the surrounding bone wall is thick, so it is not easy to damage the wing nerve during operation.
1. Cerebrospinal fluid rhinorrhea The sphenoid sinus wall is close to the posterior group. The bone plate is thin. If the dura mater is damaged during operation, the cerebrospinal fluid can be cleared. If the blood is mixed, the drip on the cloth can be seen in the center of the infiltration. The blood clot is surrounded by a colorless moisturizing circle. The test shows that the protein content is below 20mg/L and the glucose content is above 30mg. The treatment method is to find the pupil under the nasal endoscope and fill it with small muscles and fascia. It can be filled with iodoform gauze. After the patient returns to the ward, take a semi-sitting position, ban the nose, limit the amount of water input, and use broad-spectrum antibiotics that easily pass the blood-brain barrier to prevent infection. Iodoform gauze can be taken out 1 to 2 weeks after surgery. In the future, it is necessary to closely observe the signs of meningitis and brain abscess, and should be treated in time.
2. Optic nerve damage Optic nerve is located at the intersection of the sphenoid sinus wall and the outer wall, that is, the uppermost part of the outer wall. When the surgical instrument touches the optic nerve, the patient may have a sense of flash. The operation should be stopped immediately and the visual acuity should be checked. The sphenoid sinus cavity does not need to be filled, so as to avoid Optic nerve compression, postoperative injection of dexamethasone 5mg / kg, a total of 3 days, check vision, if vision continues to decline, you can strive for decompression of the optic canal.
3. Internal carotid artery rupture of the sphenoid sinus surgery, sudden emergence of massive hemorrhage, must be the internal carotid artery rupture, should immediately fill the sphenoid sinus wall with iodoform gauze, stop the operation, return the patient to the ward for blood transfusion, two weeks After the iodoform gauze is slowly withdrawn, if it still bleeds, it is necessary to compress the tamponade or use a detachable balloon to embolize the ruptured internal carotid artery through the arterial catheter under fluoroscopy.
Symptom
Chronic sphenoid sinus symptoms Common symptoms Purulent secretions Mucosal congestion Neuralgia Facial pain Dizziness Olfactory loss Polyps Dizziness Toothache Sella deformation
According to 58 cases of nasal endoscopy, single sphenoid sinusitis accounted for 34%, 14% with the posterior group of ethmoid sinusitis, 19% with the former group of sinusitis, and 33% with total sinusitis.
Some patients with this disease have no complaint symptoms or symptoms are not significant. If you ask carefully, you may have the following symptoms:
1. The headache is often located behind the eyeball, with the top of the head and the occipital part, which is exacerbated at night or after drinking.
2. Reflex neuralgia can have facial pain, toothache, mastoid, neck, shoulder and other neuralgia.
3. Olfactory disorders are often olfactory loss of unknown cause.
4. Dizziness is unsteady, swinging left and right, but no directional skew, different from ear vertigo.
5. After nasal drip, there may be purulent secretions flowing from the posterior nostrils to the pharynx when the head is lowered or when the head position changes, and the symptoms are temporarily relieved after the spit.
Check the traditional examination method is to anesthetize the surface of the nasal cavity, extend the long nose into the nasal cavity, push the middle turbinate outward, sometimes there are purulent secretions in the sphenoid sinus, the olfactory fissure also has pus, the butterfly crypt crypt mucosa congestion The mucosa of the posterior pharyngeal wall is thickened and thickened. It can be seen that there is pus at the posterior nostril, but it is difficult to observe because of poor illumination.
Fiberoptic light nasal endoscopy, visible mucosal edema in the upper nasal passage and stencil crypt, polypoid changes, and purulent secretions, there may be polyps obstruction at the sphenoid sinus, mucosal congestion and purulent secretion after contraction Because of the high visibility of this method, the lesion is not difficult to find.
Examine
Chronic sphenoid sinus examination
1. X-ray nasal position can be seen in the ethmoid sinus shadow blur and lesion range.
2. CT coronal scan showed thickening of ethmoid sinus mucosa and bone destruction at the top of the sieve. Axial scanning showed the extent of the lesion and the presence or absence of defect or bone destruction.
3. Test puncture first use 1% of the adrenal gland 1% of the cardine cotton film to shrink the middle nasal passage, parallel mucosal surface anesthesia, then use a 5th long needle to pierce the sieve, inject a small amount of sterile saline, extract, check Whether it is turbid or not, it can also be used for bacterial culture and antibiotic susceptibility test. This method has certain difficulty and danger and must be operated by experienced physicians.
Diagnosis
Diagnosis and diagnosis of chronic sphenoid sinusitis
It is differentiated from chronic rhinitis, acute sinusitis, chronic frontal sinusitis, and chronic ethmoid sinusitis.
