chronic ethmoid sinusitis
Introduction
Introduction to chronic ethmoid sinusitis In the sinus, the anatomy of the ethmoid sinus is the most complicated, especially the semilunar hole at the opening of the anterior ethmoid sinus and its nearby uncinate process and sieve funnel. It is a small protrusion and groove-like gap in the middle nasal passage, called sinus nose. Road complex. This is where the nasal inhalation airflow is impacted, and it is also the most invasive part of bacteria, viruses, and inhaled antigens (allergens). Regardless of infection or allergic reaction, it begins with swelling of the mucosa, ciliary movement stops, ethmoid sinus ventilation and drainage are blocked, and then spread to other sinuses. Because the ethmoid sinus drainage is not smooth, if the inflammation is not easy to dissipate, it is easy to prolong to become chronic and become chronic ethmoid sinusitis. basic knowledge The proportion of sickness: 0.01% Susceptible people: no special people Mode of infection: non-infectious Complications: epistaxis, subdural hematoma, intracranial hemorrhage, meningitis, subdural abscess, brain abscess, eyeball
Cause
Cause of chronic ethmoid sinusitis
There are three types of mucosal lesions: polyps, hypertrophy and atrophy. There are three types of bone wall lesions:
1. Proliferative bone lesions are stimulated by submucosal congestion, and proliferative osteitis occurs in the bone wall, which makes the bone wall of the sieve room hard.
2. Atrophic bone lesions are caused by long-term compression of polyps and hypertrophic mucosa due to the bone wall of the sieve wall, resulting in insufficient blood supply and thinning or disappearance of the bone wall.
3. Ulcerative bone lesions due to thrombotic venipitis of the mucosa, spread to the bone wall, and cause necrosis of the bone wall of the sieve room. Each sieve room can be fused into a large cavity with pus in the cavity. If the infection is serious, Intraorbital or intracranial complications can occur.
Prevention
Chronic ethmoid 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 ethmoid sinus complications Complications, epistaxis, subdural hematoma, intracranial hemorrhage, meningitis, subdural abscess, brain abscess, eyeball
Common complications of ethmoid sinus surgery In sinus surgery, ethmoid sinus surgery is most prone to surgical complications, because the ethmoid sinus is the smallest of the sinuses, according to Rice (1989), the normal development of the ethmoid sinus is 4 to 5 cm long. The front screen height is 2.5cm, the width is 0.5cm, the rear screen width is 1.5cm, and the sieve top width is 0.3cm. Surgery is carried out in such a narrow range. If the bleeding or illumination is not good, it is easy to damage the outer wallpaper template and the sieve at the top of the sinus sinus. Plate, in the above various ethmoid sinus resection, intranasal ethmoid sinus surgery is most likely to occur intraorbital and intracranial complications, Lima surgery followed, nasal ethmoid sinus surgery is the least, in recent years carried out within the functional Speculum sinus surgery, although advanced surgical equipment, but the experience of the surgeon is not rich, there are reports of complications at home and abroad.
1. Intracranial complications are life-threatening
(1) skull base bone injury: cerebrospinal fluid rhinorrhea, intracranial gas (gas brain), often due to surgical equipment operation is too upward, beyond the attachment of the middle turbinate, the appearance is higher than the medial plane.
(2) intracranial hemorrhage: subdural hematoma, frontal lobe hematoma, cavernous sinus, internal carotid artery spasm, due to sharp forceps to clamp up the sinus sinus top tissue, or clamped tissue damage blood vessels in the sphenoid sinus side wall, If the internal carotid artery ruptures, the patient can quickly die of nosebleeds.
(3) intracranial infection: common meningitis, subdural abscess, brain abscess.
2. Blinking complications: risk of blindness
Mainly manifested as eyeballs, visual impairment, ophthalmoplegia (strabismus, double vision), tearing, etc., for the following reasons:
(1) Damage of the paper plate: only the sacral emphysema in the light, the blood in the ankle under the skin, and the rupture of the anterior ethmoid artery causes the hemorrhage in the sac, which can be blinded quickly. If the rectus muscle is damaged, the strabismus can appear. And double vision.
(2) Optic nerve injury: including optic nerve tube segment and posterior segment injury. If the tissue taken out during surgery contains yellow soft intra-abdominal fat, it may damage the optic nerve, the internal iliac crest and the internal rectus muscle, which may cause reflex omental or Embolization, leading to blindness.
(3) lacrimal duct injury: including lacrimal sac and nasolacrimal duct, the main signs are tearing.
(4) Intra-orbital infection: There are periostitis, intraorbital cellulitis, intraorbital abscess, etc., which can occur several days after surgery. The main symptoms are fever and eye pain.
3. Intranasal complications
(1) The sense of olfactory loss or loss is often caused by excessive mucosal loss in the olfactory area.
(2) nasal sinus adhesion: the middle nasal passage complex adhesion, can lead to functional endoscopic sinus surgery failure.
Symptom
Chronic ethmoid sinus symptoms Common symptoms Nasal olfactory olfactory dysfunction Head dizziness Purulent secretions Facial pain Neuropathic polyps Attention distraction Toothache
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. Headache: It 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: There may be facial pain, toothache, mastoid, neck, shoulder and other neuralgia.
3. Olfactory disorders: often loss of sense of smell for unknown reasons.
4. Dizziness: Unsteady walking, swinging left and right, but no directional skew, different from ear vertigo.
5. After nasal drip: Puseptic secretions can flow 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.
Chronic ethmoid sinusitis rarely occurs alone, and the symptoms are not typical. Symptoms such as neuralgia, depression, and inattention are more common. When the sinus is blocked, there may be nasal root or eyelid swelling and nasal congestion. Olfactory disorder, rhinorrhea in the back of the nose.
Clinical examination showed that the polyps blocked the middle nasal passages, the middle turbinate and the nasal septum were hypertrophied, the olfactory fissure, and the middle nasal passages had purulent secretions.
Examine
Chronic ethmoid 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: firstly use the 1% cain cotton sheet containing 1 adrenal gland to contract the middle nasal passage, and the mucosal surface anesthesia, then use the 5th long needle to pierce the sputum, inject a small amount of sterile physiological saline, and withdraw. Check for turbidity, bacterial culture and antibiotic susceptibility testing. This method is difficult and dangerous and must be operated by an experienced physician.
Diagnosis
Diagnosis and diagnosis of chronic ethmoid sinusitis
It is differentiated from chronic rhinitis, acute sinusitis, chronic frontal sinusitis, and chronic sphenoid sinusitis.
