suppurative sinusitis
Introduction
Introduction to suppurative sinusitis Sinus purulent lesions are a common disease in children. In recent years, they have received increasing clinical attention. Some scientists have performed sinus X-ray examinations in children who are generally healthy and found that about 50% of sinuses have lesions. These children undergo a maxillary sinus puncture flush, and about one-third of them can flush out the pus. Blockage of the sinus ostium for various reasons can be a causative factor of infection. The main clinical manifestations are nasal congestion, purulent fistula, headache and local tenderness. basic knowledge The proportion of illness: 0.06% Susceptible people: good for children Mode of infection: non-infectious Complications: epidural abscess subdural abscess purulent meningitis brain abscess
Cause
Causes of suppurative sinusitis
Nasal infection (25%):
Often secondary to respiratory infections or acute rhinitis. High dislocation of the nasal septum, hypertrophy of the middle turbinate, nasal polyps, nasal tumors, foreign bodies or tamponade for too long can prevent the sinus drainage and cause disease. Improper diving or diving during swimming can cause sewage to enter the sinus through the nasal cavity.
Odontogenic infection (20%):
The second double canine and the root of the first and second molars are located on the bottom wall of the maxillary sinus. When the root infection occurs, the sinus wall may be worn, or the basal wall may be damaged when the tooth is extracted. Severe maxillary sinusitis.
Trauma (20%):
The antrum of the anterior group, especially the maxillary sinus and frontal sinus, is superficial and vulnerable to trauma and fracture. The bacteria can invade the sinus from the skin or nasal mucosa. It can also cause infection due to foreign matter such as shrapnel and dust.
Air pressure change (20%):
During aviation, diving, and mountaineering, it may cause damage due to sudden changes in air pressure and negative pressure in the nasal cavity. It is called barotrauma sinusitis.
Prevention
Suppurative sinusitis prevention
1. Usually pay attention to nasal hygiene.
2. Pay attention to the method. Those with more nasal congestion should press the nostrils on one side and apply a little force to the outside. Then alternate and linger.
3. The posture should be correct when swimming, try to make the head out of the water.
4. Those who have dental problems should be treated thoroughly.
5. When you have an acute attack, take more rest. The bedroom should be bright to keep indoor air flowing. But avoid direct blowing and direct sunlight.
6. Follow the doctor's advice and use it in time.
7. Chronic sinusitis, treatment should have confidence and perseverance, pay attention to strengthen exercise to enhance physical fitness.
8. No smoking, alcohol or spicy food.
9. Keep your temperament open and mentally avoid irritating, and be careful not to overwork.
10. Usually do a nasal massage.
Complication
Septic sinusitis complications Complications, epidural abscess, subdural abscess, purulent meningitis, brain abscess
Ocular complications: humeral wall osteoarthritis, periostitis, subperiosteal abscess of the temporal wall, intraorbital cellulitis, intraorbital abscess, retrobulbar optic neuritis.
Intracranial complications: epidural abscess, subdural abscess, purulent meningitis, brain abscess, cavernous sinus thrombophlebitis.
Symptom
Suppurative sinus symptoms Common symptoms Nasal nasal purulent odor sinus tenderness Nasal mucosa swelling Mucosal congestion Appetite chills Fever fever
In the acute phase, it is characterized by nasal congestion, purulent sputum and headache. The systemic symptoms include chills, fever, fatigue, loss of appetite, examination of nasal mucosa congestion, swelling, and a large amount of purulent sputum in the nasal cavity. In the chronic phase, multiple pus or purulent sputum in the nasal cavity is the main symptom. Systemic symptoms are generally not obvious.
Examine
Examination of suppurative sinusitis
1. X-ray plain film: the side wall of the paranasal sinus lined with a linear or wavy thickened mucosa, sinus effusion (pus), sinus cavity gas-liquid plane shadow (sitting position) or universal density, sinus wall There is hardening and whitening.
2. CT manifestations: thickening of the sinus mucosa, uniform or slightly wavy soft tissue density lining shadow, irregular surface ring enhancement. The sinus cavity fluid can be soft tissue density (pus). The sinus wall is thickened and the density is increased. When combined with sinus polyps, single or multiple round or oblong soft tissue density can be seen, no enhancement.
3. MRI performance: the gas in the sinus cavity disappears, and the T1 low signal and the T2 high signal are uniformly turbid. There is no damage to the bone wall. Intravenous (Gd) enhanced T1 weights are seen as uniform enhancement of thickened mucosa.
Diagnosis
Diagnosis and differentiation of suppurative sinusitis
Differential diagnosis
Need to identify with non-suppurative sinusitis, malignant tumor of the sinus.
Malignant tumor of the sinus: early stage of maxillary sinus malignancy, unilateral pus and bloody nose, pain and numbness in the cheeks, unilateral progressive nasal congestion, unilateral maxillary molar pain or looseness. In the advanced stage, the tumor tissue spreads to adjacent tissues, the cheeks are raised, the face is asymmetrical, the eye symptoms, tears appear, the eyeballs shift, the hard palate is raised, the alveolar is thickened, the teeth are loose or shedding, the mouth is difficult, and the skull base is involved. The lymph nodes are transferred to the neck.
