chronic maxillary sinusitis
Introduction
Introduction to chronic maxillary sinusitis Chronic maxillary sinusitis is a common and frequently-occurring disease in the otolaryngology department. The incidence of the disease is caused by factors such as prolonged inflammatory reaction of the surrounding tissues, obstruction of sinus drainage, weakened systemic resistance, and odontogenic infection. Patients with dizziness, headache, and nasal obstruction all year round, especially in winter; severe cases can be accompanied by inflammatory reactions such as pharynx, flat corpus callosum, larynx, trachea, bronchus and lung. Surgical treatment is an important treatment for this disease. With the maturity of modern endoscopic sinus surgery technology, the cure rate is greatly improved. However, in clinical practice, the traditional maxillary sinus radical surgery and other surgical methods are still the treatment of the upper jaw. Convenient, safe and effective nasal surgery for sinus disease. basic knowledge The proportion of illness: 0.35% Susceptible people: no special people Mode of infection: non-infectious Complications: fainting, air embolism, nosebleed, swelling
Cause
Causes of chronic maxillary sinusitis
1. Systemic resistance reduces anemia, hypoproteinemia, low immunoglobulinemia, diabetes and malnutrition, etc. The maxillary sinus is not easily cured after bacterial infection, often developing chronic maxillary sinusitis, and there are many maxillary sinusitis Without an acute medical history, it is chronic at the beginning.
2. sinus drainage obstruction of the maxillary sinus natural opening position in the middle nasal tract variation, easy to block, such as uncinate process, middle turbinate hypertrophy, bubble middle turbinate, nasal septum high curvature and nasal polyps, etc., can hinder the maxillary sinus opening, affecting it Ventilation, drainage and mucociliary clearance can lead to chronic inflammation.
3. The anterior ethmoid sinus of the ethmoid sinus extends to the inner upper corner of the maxillary sinus, the bone wall is very thin, the infection is easy to spread to the maxillary sinus, and the purulent discharge of ethmoid sinus passes through the middle nasal passage. Flowing into the maxillary sinus is also one of the common causes.
4. Nasal allergic reaction due to edema of the maxillary sinus mucosa, cilia elimination dysfunction, may lead to sinus ventilation and poor drainage, and chronic inflammation, that is, allergies and inflammation mixed.
5. Tooth-borne infection.
Prevention
Chronic maxillary sinusitis prevention
Active treatment of acute rhinitis, acute sinusitis and so on.
Complication
Chronic maxillary sinusitis complications Complications, faint air embolism, nosebleeds, swelling
1. Common complications of maxillary sinus puncture washing:
Fainting
It is a neurological factor that causes central dysfunction of the reflex vascular movement, leading to a temporary loss of consciousness in the brain anemia, excessive mental stress, pain, weakness, hunger, fatigue, excessive indoor water vapor, air non-circulation, etc. The author believes that the medical staff's language behavior is rude, so that patients lose trust, there is a certain relationship, so the patient should be explained in detail before puncture, from time to time to ask the patient to feel, the early symptoms of fainting are fatigue, chest tightness, nausea, tinnitus, black sputum, Dizziness, sitting instability, but not too late to tell the doctor that they fainted and lost consciousness. The patient was pale, sweaty, superficially breathing, slow pulse, slightly lower blood pressure, and less severe to the stimulus and dilated pupils. This process is very short, about a few seconds to a few minutes, the patient's consciousness gradually recovers, let the patient take the lying position or the head low position, keep the breathing smooth, acupuncture the middle point, inhale oxygen, drink a cup of hot water, and should not puncture again.
2. collapse
For acute systemic vascular tone reduction and heart failure, it is prone to chronic wasting disease, lack of stress response and low cortisol secretion, pain and mental stress are the cause, symptoms are more serious than fainting, showing pale skin , purpura, weak pulse and frequent frequency, shallow breathing, lower blood pressure, lower body temperature, consciousness, can not recover quickly, collapse is generally reversible, but if it can not be rescued in time, may be life-threatening, for the long-term bedridden patients with maxillary sinus When puncture, be fully prepared. Such as infusion, correct electrolyte imbalance, and give hormones, should take the lying position when puncture, for those who have collapsed should pay attention to blood pressure, pulse and breathing, you can immediately intravenous injection of 10% glucose solution 40 ~ 60ml.
3. Air embolism
This complication is less, but it is fatal. Because the needle penetrates into the vein of the maxillary sinus mucosa during puncture, after flushing, it injects air into the sinus, which is caused by the liquid left in the sinus. The air passes through the facial vein and neck. The internal vein to the right heart, or the bubble enters the medulla of the brain, embolizes the respiratory center and dies. The patient can feel the bubble in the neck of the operation during the insufflation, and then the face is cyanotic, dumped, lost consciousness, and quickly stop the heartbeat. Death, rescue should prompt the patient to take the head low position, lying on the left side, to avoid more air bubbles into the brain, left heart system and coronary artery, artificial respiration, oxygen inhalation, in need of cardiac massage and cardiac puncture Aspirate the gas in the heart.
4. Topical anesthesia allergic reaction
The incidence is not high, but it can be fatal. It manifests as the central nervous system is irritated from top to bottom, such as convulsions, convulsions, breathing changes from irregular to stopped, blood pressure drops, consciousness changes from excitement to loss, pupils are small Become bigger, rescue should use anti-caries agents, artificial respiration and pacemakers.
2. Common complications of maxillary sinus fistula:
1. Nasal lacrimal duct injury After the operation, the affected side has long-term tearing. Because the location of the ostomy is too much before the establishment, it has been advocated in recent years to change the position of the ostomy to the middle of the lower nasal passage.
2. Nose bleeding is caused by the position of the ostomy, which is damaged by the nasal branch of the aorta, or too far forward, and the nasal branch of the upper lip is damaged.
3. The inferior turbinate nasal septum adheres to the inferior turbinate and the side wall of the nasal cavity, due to improper handling after surgery.
3. Common complications of maxillary sinus radical surgery:
1. Postoperative bleeding According to domestic statistics, the incidence rate is 2.4% to 7%, which occurs within 24 hours after surgery. The edge of the anterior wall of the maxillary sinus or the arterioles at the edge of the hole may be caused by injury to the inferior turbinate. Compression can be used to stop bleeding; the subsequent hemorrhage is secondary hemorrhage, often caused by mucosal infection in the sinus. If there is more bleeding, the maxillary sinus can be explored from the original incision, the hemorrhage mucosa can be removed, and the bleeding can be stopped.
2. Facial swelling This disease belongs to post-operative reaction. It is caused by a large amount of high-concentration local anesthetic buccal submucosal injection. The hook is too hard and the operation time is too long. The treatment method is to take out the stuffing in the sinus early and apply heat on the face. Use antibiotics to prevent infection.
3. The numbness of the upper lip and the upper column are caused by the surgical incision to damage the infraorbital nerve, or because the incision is close to the midline, and the maxillary incisor nerve is damaged. It takes several months or a year to recover.
Symptom
Chronic maxillary sinus symptoms common symptoms dizziness purulent secretion mucosal atrophy cyst scar squamous epithelium
1. Ask about the history of acute rhinitis, acute sinusitis and treatment, and ask if there is a history of nasal allergies.
2. Nasal examination Note whether the middle turbinate has hypertrophy or polyps, whether there is obstruction or purulent secretion in the middle nasal passage, whether there is any deviation in the nasal septum, and then contract the nasal mucosa with 1% ephedrine cotton, then do the head test. The affected maxillary sinus was placed in the upper side, and after a few minutes, the pus out of the middle nasal passage was observed.
3. X-ray film taken the nasal position (water position), observe the density of the maxillary sinus on both sides, compared with the density of the eyelid, greater than the density of the eyelids, indicating that the shadow is blurred, should be suspected of mucosal thickening or purulent discharge in the sinus Should be further examined.
4. Maxillary sinus angiography After the maxillary sinus irrigated, 2ml of lipiodol was injected into the sinus, the head position was changed, and X-ray was taken to observe whether the mucosa was thickened and polyps, as well as intrasinosal tumor, cyst and sinus cavity. The thickness of the mucosa above 3 mm is thickened.
5. The mucosal clearance test was performed on the 4th day after lipiodol angiography. The iodized oil should be emptied in patients with normal mucosal clearance. If iodized oil remains in the maxillary sinus, it means that the mucosa loses its function of clearing.
6. Maximal sinus resistance measured the maxillary sinus penetration side, water is injected into the sinus. When the liquid flows out smoothly, measure the water column pressure of the pressure measuring tube. If the sinus mouth resistance is still 6 kPa after 3 to 4 times of washing, it is necessary. Surgical treatment.
7. Maxillary sinus endoscopy This is the latest method for diagnosing maxillary sinus lesions. It was applied to the clinic by Messerklinger et al. in the 1970s. Pathological biopsy can be taken in the sinus under cold light illumination, or recorded. Image can overcome the blindness of examination and improve the diagnosis rate.
Chronic maxillary sinusitis has different lengths and pathological changes. It can be divided into polyps, nipples, follicles, glands and fibrils. Various types of inflammation often mix or change with each other.
1. Polyp type, also known as hypertrophic type and edema type, often associated with allergic reaction, mucosa with varying degrees of edema, lymphocytes, plasma cells and eosinophils infiltrating, severe polyps and cystic changes, long This sliding wall is loosely changed.
2. The papillary hyperplasia mucosa changes from pseudo-stratified columnar epithelium to stratified squamous epithelium, and the thickening of the surface layer is papillary, which is related to viral infection and bacterial invasion.
3. The follicular mucosa has a large number of lymphocytes aggregated and is follicular.
4. Glandular type has mucinous gland and serous gland hyperplasia, and glandular obstruction also forms cysts.
5. Fibrous type, also known as sclerotic or atrophic type, often with small arterial endometritis and periarteritis, causing arterial obstruction, insufficient mucosal blood supply, degeneration of glands, reduced secretion, thickening, and even mucosal atrophy, cilia disappear And scar formation.
[clinical manifestations]
Mainly for the affected side or bilateral sinus, anterior nasal drip or posterior nasal drip, sometimes nasal secretions flow out with changes in head posture, patients complained of sputum and stink, secretions are mucopurulent or purulent, patients often have Dizziness or purulent, patients often have dizziness and headache, memory loss, thought can not be concentrated, but some patients forget their symptoms, and until the nasal examination found chronic maxillary sinusitis.
Examine
Chronic maxillary sinusitis
1. Nasal examination Note whether the middle turbinate has hypertrophy or polyps, whether there is obstruction or purulent secretion in the middle nasal passage, whether there is any deviation in the nasal septum, and then contract the nasal mucosa with 1% ephedrine cotton, and then do the head position test. The affected maxillary sinus was placed in the upper side, and after a few minutes, the pus out of the middle nasal passage was observed.
2. X-ray film taken the nasal position (water position), observe the density of the maxillary sinus on both sides, compared with the density of the eyelid, greater than the density of the eyelids, the shadow is blurred, it should be suspected that the mucosal thickening or purulent discharge in the sinus Should be further examined.
3. Maxillary sinus angiography After the maxillary sinus lavage, 2ml of lipiodol was injected into the sinus, the head position was changed, and X-ray was taken to observe whether the mucosa was thickened and polyps, as well as intrasinosal tumor, cyst and sinus cavity. The thickness of the mucosa above 3 mm is thickened.
4. Mucosal clearance function test On the 4th day after lipiodol angiography, the test should be performed again. The iodized oil should be emptied in patients with normal mucosal clearance. If iodized oil remains in the maxillary sinus, it means that the mucosa loses its function of clearing.
5. The maxillary sinus resistance is measured on the maxillary sinus and the sinus is injected into the sinus. When the liquid flows out smoothly, the water column pressure of the pressure measuring tube is measured. If the sinus resistance is still 6 kPa after 3 to 4 times of washing, it is necessary. Surgical treatment.
6. Maxillary sinus endoscopy This is the latest method for diagnosing maxillary sinus lesions. It was applied to the clinic by Messerklinger et al. in the 1970s. Pathological biopsy can be taken in the sinus under cold light illumination, or recorded. Image can overcome the blindness of examination and improve the diagnosis rate.
Diagnosis
Diagnosis and diagnosis of chronic maxillary sinusitis
It is differentiated from chronic rhinitis and acute sinusitis.
