DISORDERS OF PARANASAL SINUS

October 5, 2024
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 TOPIC: DISORDERS OF PARANASAL SINUS

🌟 IMPORTANT POINTS TO REMEMBER

🔸Sinusitis: Sinusitis is the inflammatory condition that causes generalised inflammation of the PNS mucous membrane. 

🔸Pansinusitis: All the sinuses will be involved, and may be unilateral or bilateral. There is fever, general malaise, bodyache and headache, usually confined to forehead, and there is also postnasal discharge.

🔸Postural Test: If no pus is seen in the middle meatus, it is decongested with a pledge of cotton soaked with a vasoconstrictor and the patient is made to sit with the affected sinus turned up.

🔸Radiographic Patterns Of Sinusitis: The opacification of sinuses leads to various radio-opaque patterns that can be revealed in Waters view as localised mucosal thickening at the sinus floor, generalised thickening of the mucous membrane around the entire wall of the sinus, complete filling of the sinus except about the ostium on the medial wall and complete filling of the sinus.

🔸Chronic Sinusitis: It is sequelae of either acute or subacute sinusitis that has failed to resolve in 3 months. Purulent nasal discharge is the most common complaint. Local pain and headache are often not marked except in acute exacerbations. The bony remodelling and thickening due to osteitis, and polyposis may be commonly associated with chronicity.

🔸Complications Of Sinusitis: There is chronic rhinosinusitis, descending infections, osteomyelitis, meningitis, encephalitis, subdural abscess, septic venous thrombosis, polyarthritis and tenosynovitis.

🔸Thickened Mucous Membrane (mucositis): Inflammation of the mucosal lining of the sinus is called mucositis. A radio-opaque non-corticated band that parallels the bony contours of the sinuses is present.

🔸Polyps: Polyps appear as irregular folds or pedunculated soft-tissue masses of oedematous hyperplastic mucous membrane in the sinuses. They appear as homogeneous radio-opaque masses with smooth, outwardly convex borders.

🔸Saint Triad: Polyps are associated with ‘Saint triad’, i.e. nasal and antral polyposis, aspirin sensitivity and asthma.

🔸Retention Pseudocyst: It is also known as benign mucous cyst, mucous retention cyst and mesothelial cyst. It has got seasonal variation and postnasal drip. Pseudocysts usually appear as broad-based, dome-shaped radio-opaque masses with smooth well-defined outline.

🔸Mucocele: A mucocele is an expanding fluid-filled destructive lesion that results from a chronically blocked ostium of a sinus.

🔸Retention Pseudocyst, Surgical Ciliated Cyst (postoperative maxillary cyst): It usually arises at the site of previous operations such as maxillary osteotomy, Caldwell–Luc operation and apicoectomy. It leads to considerable destruction of the antrum and related symptoms.

🔸Maxillary Sinus Malignancy: Epiphora is caused by obstruction or infiltration of the lacrimal duct situated in the anteromedial aspect of the maxilla. There is trismus and hearing loss. It will be having radio-opaque appearance; it destroys the sinus walls, causing irregular radiolucent areas in the surrounding bone, bone destruction or irregular widening of PDL space around the teeth.

🔸Oroantral Fistula: Oroantral fistula is opening between oral cavity and maxillary sinus. After oroantral opening is established into fistula, it may result in foul, fetid and salty taste in mouth. Radiograph will show break in the continuity of floor of maxillary sinus.

📣 CLASSIFICATION : 

➡️ Sinusitis is classified in various ways.

💠 DEPENDING ON DURATION

  • Acute: Present for less than 2 weeks
  • Subacute: Present for 2 weeks to 3 months
  • Chronic: Present for more than 3 months

👉 Depending On Drainage

  • Open: Drainage present
  • Closed: No drainage and symptoms will be very severe

👉 Depending On Sinus Involvement

  • Maxillary
  • Frontal
  • Sphenoid
  • Ethmoid

👉 Depending On Number Of Sinus Involvement

  • Multisinusitis: More than one sinus involved but not all.
  • Pansinusitis: All the sinuses will be involved, may be unilateral or bilateral.

👉 Depending On The Type Of Organism

  • Bacterial
  • Viral
  • Fungal

📣 STAGING SYSTEM FOR SINUSITIS

🔺Kennedy Staging

🔹It was given in 1992 and this stage is based on history, CT finding and endoscopic appearance.

🔹Four stages are given: stages I, II, III and IV.

🔺Levine and May Staging

🔹It was given in 1993, and it considers involvement of osteomeatal complex.

🔺Lund–Mackay Staging

It was given in 1993 and it is most accepted.

🔹Stage 0: No abnormality

🔹Stage 1: Partial opacification

🔹Stage 2: Total opacification.

🔺Harvard Staging

🔹It was given in 1994 and staging is similar to Kennedy staging, but takes consideration of thickening of inflammatory disease.

🔹According to this staging, 2 mm is the normal thickness of the sinus lining. Anything more than 2 mm is a disease.

📌 MULTIPLE CHOICE QUESTIONS (MCQs)

💡The main vertical portion of frontal sinuses is best visualised in

  1. Waters view
  2. Lateral cephalogram
  3. Caldwell view
  4. Both a and c

Answer : 4

💡Anterior and posterior sinus walls of frontal sinus are best visualised in

  1. Submentovertex
  2. PA skull
  3. Lateral cephalogram
  4. Orthopantomogram

Answer : 1

💡Pyocele and mucopyocele are the synonyms of

  1. Polyps
  2. Mucositis
  3. Retention pseudocyst
  4. Mucocele

Answer : 4

💡Which of the following is the classification and staging for maxillary sinus carcinoma?

  1. Ohngren classification
  2. Lederman classification
  3. Caldwell classification
  4. Both a and b

Answer : 4

💡When fibrous dysplasia involves posterior maxilla, the radiographic appearance shown is

  1. Ground-glass appearance
  2. Orange peel appearance
  3. Soap bubble appearance
  4. Both a and b

Answer : 4

💡CT findings in recent polyps which are having mucoid attenuation with mucosal enhancement at the polyp surface are

  1. 10–18 HU
  2. 15–20 HU
  3. 20–35 HU
  4. None of the above

Answer : 1

💡CT findings in older polyps which are having mucoid attenuation with mucosal enhancement at the polyp surface are

  1. 10–18 HU
  2. 20–35 HU
  3. 25–35 HU
  4. None of the above

Answer : 2

💡Oedema of lids, and puffy and swollen eyelids with increased lacrimation are seen in

  1. Polyps
  2. Antroliths
  3. Acute ethmoidal sinusitis
  4. Oroantral fistula

Answer : 3

💡If mucormycosis involves the carotid artery, then the investigation required is

  1. Ultrasonography of the effected region
  2. MRI
  3. Angiography
  4. CT

Answer : 3

💡Saint triad refers to

  1. Nasal and antral polyposis, aspirin sensitivity and asthma
  2. Pedunculated polyp obstructed middle meatus
  3. Epiphora, hearing loss and diplopia
  4. None of the above

Answer : 1

Oral Medicine and Radiology