Complications of Sinusitis

COMPLICATIONS OF SINUSITIS
  • Pansinusitis
  • Otits media,Pharyngitis,Laryngitis,Tracheo-bronchitis.
  • Osteomyelitis of the Maxilla due to maxillary sinusitis
  1. Characterized by pain and swelling in the maxillary region.Radiological examination may show bony necrosis.
  2. Treatment:Surgical Drainage through medial wall of Antrum
  • Mucocele
  • Oro-antral Fistula
  • Dental Abscess
  • Ophthalmic complications:
  • Peri-orbital and Orbital Cellulitis or Abscess
  1. May occur secondary to Maxillary,Ethmoid or Sphenoid Sinusitis.
  2. May occur due to Faciomaxillary trauma and as a complication of Endoscopic sinus surgery.
  3. Orbital complications are commoner in children.
  4. In case of Orbital Abscess-early drainage is required to prevent pressure necrosis of orbital nerve and blindness.
  5. Surgical Drainage via incision in the superomedial aspect of the orbit.
  • Osteomyelitis of frontal bone due to Frontal Sinusitis
  1. May be associated with sequestrum formation and fistula may form.
  2. Oedema of the forehead situated slighly above the upper limit of frontal sinus called Pott's Puffy Tumor.
  3. Treatment:Surgical Drainage through floor of sinus
  • Cavernous Sinus Thrombophlebitis
Etiology:
  • Infection may spread from:
  • a.)Paranasal Sinuses:particularly Ethmoidal,Sphenoidal and Frontal Sinuses.
  • b.)Dangerous Area of the face:including external nose,vestibule,septum and upper lip.
  • c.)Orbital Cellulitis and Abscess
  • The spread is via Ophthalmic veins.
Clinical Features:
  1. General:fever,malaise,rigors,septicemia,pyemia
  2. Ophthalmic:Swellingofthe eyelids with chemosis and proptosis.Ophthalmoplegia.Pupils become dilated and fixed with optic disc edema and loss of vision.
  3. Cranial Nerves:3rd,4th,5th,6th cranial nerves may get paralyzed.
  • Investigations:
  1. Blood culture,Fundoscopy,CT scan
  2. Treatment:Antibiotics,Anticoagulants,Treatment of the primary cause.
  3. Intracranial Complications:Epidural Abscess,Subdural Abscess,Meningitis and Frontal lobe Abscess.
  • Frontal lobe abscess:
  • Personality changes may occur in case of frontal lobe absess.
Exam Question
  • Pott’s puffy tumor is a complication of frontal sinusitis due to osteomyelitis of frontal bone . 
  • The probable diagnosis in a patient with history of running nose and pain over medial aspect of the eye presenting with sudden onset of high grade fever, prostration, chemosis, proptosis and diplopia on lateral gaze with congestion of the optic disc would be Cavernous Sinus Thrombosis.
  • Complications of acute sinusitis are Orbital cellulitis,Pott's puffy tumor and Conjunctival chemosis.
  • Orbital cellulitis may occur as a complication of Parasinusitis, Faciomaxillary trauma,Endoscopic sinus surgery.
  • Frontal lobe abscess may be associated with fever,papilloedema,Personality changes and headache.

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