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PARANASAL SINUSES
Dr. Swati Gupta Associate professor Department of Oral Medicine and Radiology
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PARANASAL SINUSES
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THE OSTEOMEATAL COMPLEX • Region where the frontal ,anterior and middle ethmoid and maxillary sinuses
drain .
• Includes the fronto ethmoidal recess , uncinate process , hiatus semilunaris ,
ethmoid bulla , the maxillary infundibulum and ostium and the ethmoid
infundibulum .
• Disease at the OMC is the major cause of recurrent acute/chronic sinusitis .
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DISORDERS OF MAXILLARY SINUS
• TRAUMATIC-Fracture, OAF, Foreign body, haematoma, contusion
• INFECTIOUS/INFLAMMATORY – Non-specific-Mucositis, sinusitis, Antral polyps, Empyema, Periostitis – Specific- fungal(actinomycosis,mucormycosis), bacterial(Tuberculosis, Wegner’s
granulomatosis)
• CYSTS – Intrinsic-retention pseudocyst, Mucocoele – Extrinsic-odontogenic (radicular, Dentigerous and keratocyst) and non odontogenic
(Globulomaxillary, Traumatic, aneurysmal)
• NEOPLASMS • Benign
– Intrinsic-Epithelial papilloma, Osteoma – Extrinsic-Ameloblastoma, adenoameloblastoma, odontome, CEOT
• Malignant – Intrinsic-SCC, Adenocarcinoma, Ca of salivary gland origin, Sarcoma, melanoma, Lymphoma
– Extrinsic- SCC, metastatic, Ca of salivary gland origin, Sarcoma, melanoma, Lymphoma
• METABOLIC AND ENDOCRINAL- Hyperparathyroidism, fibrous Dysplasia, Paget’s Disease
• CALCIFICATIONS-ANTROLITH • SYNDROMES- Crouzon’s, Treacher Collins, Binder’s
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SINUSITIS
• ACUTE
• SUBACUTE
• CHRONIC
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DIAGNOSIS:
Xray: WATER’S
VIEW.
CT is
preferred..
ANTERIOR NASAL
ENDOSCOPY
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TRANSILLUMINATION OF MAXILLARY SINUS
TRANSILLUMINATION TEST:
TRANSILLUMINOSCOPE
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MANAGEMENT OF SINUSITIS
• Antimicrobial drugs
(ampicillin/amoxicillin/erythromycin)
• Nasal decongestant drops ( 0.1% oxy or xylometazoline).
• Steam inhalation.
• Analgesics.
• Hot fomentation.
• SURGICAL- Antral lavage
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PANSINUSITIS
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It is the sinus infection lasting for months or years.
Important cause is failure of acute
infection to resolve.
PATHOPYSIOLOGY:
Pollution,chemicals,infec
tions.
LOSS OF CILIA
IMPAIRED
DRAINAGE
Polypi,
DNS,
adenoid
s,
tumors,
allergy
INFECTION
Inadequate therapy of acute sinusitis
MUCOSAL
CHANGES ALLE
RGY
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DIAGNOSIS:
Xray (mucosal
thickening)
Xray with contrast.
CT
Aspiration( pus is
confirmatory).
TREATMENT
Cause for obstruction of sinus drainage and
ventilation to be found out.
Work up on nasal allergy may be required..
Culture and sensitivity ( selection of antibiotic).
Conservative management(antibiotics,
decongestants, antihistaminics)
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SURGICAL MANAGEMENT
• Antral puncture and irrigation.
• Intranasal antrostomy.
• Caldwell-luc operation.
Nasal antrostomy
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MUCOSITIS
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Periostitis
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Mucous Retention Pseudocyst
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POLYPS
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A left sided ethmoidal mucocele (A)
encroaching on the left orbit.
Left globe in proptosed.
T2W MR axial and coronal sections (B)
of the same patient showing
hyperintense fluid contents of the
mucocele
MUCOCELE
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OSTEOMA
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ANTROLITH
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ROOT PIECE IN
SINUS
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SCC OF MAXILLARY SINUS
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ANATOMICAL VARIANTS
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THANK YOU