Treatment of Maxillary Sinusitis

Treatment of maxillary sinusitis
Rabina panta
1701938
Introduction
The sinuses are connected system of
hollow cavities in the skull. They are
paired, air filled chambers in the
skull. Several theories propose that
they serve to lighten the skull,
protect the brain during head trauma
and add resonance to the voice.The
sinus cavities include:
• The maxillary sinuses
• The frontal sinuses
• The ethmoid sinuses
• The sphenoid sinuses
Sinusitis
It is an inflammation of linning mucus membrane of a
sinus as a result of infection, allergy, structural or
mechanical abnormalities.
• Multi sinusitis: If more than one sunus is infected.

• Pan-sinusitis: If all the sinuses are involved in the
inflammatory process.
Normally, secreted mucus is kept cleared off by the
action of gravity, aided by ciliary action but when the
ostium is obstructed the mucus collects in the sinus and
gets infected giving rise to sinusitis.
Classification
Acute sinusitis Infection of sinuses that lasts
less than two weeks and
responds to antibiotic therapy.
Infection of sinuses that

Chronic sinusitis lasts longer than two weeks
require longer courses of
medical therapy and may
require surgery.
Either acute or chronic; it starts

Recurrent sinusitis to resolve but reoccurs because
the treatment is either
inadequate or is stopped
prematurely.
Etiology
 Acute infectious fevers concerned with the respiratory tract or

through blood stream.
 Trauma (accidental)- Eg: gun shot injuries, etc. and trauma
(operative)- Eg: Polypectomy,etc.
 Infections in the pharynx, the larynx, the tracheo-bronchial tree
and lungs.
 Root abscess in teeth(bicuspid and tricuspid)
 Dental extraction leading to oro-antral fistula
 Bathing and diving in infected water.
 Wet and cold weather
 Poor state of health with lower body resistance.
Symptoms
Local
• A sense of fullness or tension around the affected sinus,
aggravated on stooping and coughing.
• Pain in cheek below the eye and upper teeth on affected side,
may refer to supra-orbital region.
• Puffiness over the face, forehead or the eyelids.
• Nasal discharge - muco-purulent or purulent, moderate in
amount.
General
• Rise of temperature
• Rise of pulse
• Other symptoms of generalized toxemia
Examination
• First of all see patient for signs like looks
very toxic with raised temperature and
pulse, flushed face and appear in agony.
On local exam:
• Anterior Rhinoscopy: Shows congestion and
swelling of nasal mucosa, septum seen in
contact with swollen turbinals with thin or
thick discharge.
• Posterior Rhinoscopy: Shows generalised
congestion and discharge sticking to the
boundries of posterior nares and walls of
naso-pharynx.
Examination
• Palpation: Elicits tenderness over the
affected sinus. Tapping over the affected
sinus is also helpful, hyperasthesia tested
with wool or pin prick gives additional
information.
• Trans-illumination test: A small li bulb is
placed in patient's mouth in the dark room,
if both sides illuminate equally they are
either healthy or infected. If one side less
illuminates than other that side may be
infected cause of pus, blood or growth of
antrum. TEST is not carried out below age
of 9 and is only 50% trustworthy.
• X-rays: 90% trustworthy when taken in suitable
position, false haziness of sinus means thickened
mucosa, growth or blood in the sinus, thick normal
bones or swollen overlying tissues unless fluid level
can be seen in the suspected sinus; therefore, x-
rays should be considered in association with
history and clinical examination.
• Sinogram: Utrasonic examination of a sinus to
differentiate fluid or mucosal thickening from solid
growth.
• Sinocopy: Physical examination of a sinus by
fibrotic sinoscope.
• CT scan: Imaging studies
• MRI: Used to acess soft tissue changes and
evaluate the extent of sinus tumor.
Signs of complications
1. Generalised persistent headache
2. Vomiting
3. Convulsions
4. Chills and high fever
5. Edema or increasing swelling of the forehead or
eyelids
6. Blurring vision, diplopia or persistent retroocular
pain
7. Signs of increased intracrial pressure
8. Personality changes or dulling of the sensorium
Treatment
Inflammatory sinus is first treated conservatively with medication.

Antibiotics: Acute and chronic sinus infections should be treated with antibiotic
to eradicate causative bacteria. Ideally antibiotic is choosen after a nasal swab
for C/S or sinus aspirate for C/S.
Generally, treatment is started with broad spectrum antibiotics, i.e. ampicillin or
amoxicillin (14 days for acute sinusitis and 3-4 weeks for chronic sinusitis). They
are effective against the most likely pathogens; if ineffective second generation
cephalosporin may be given for 3-6 weeks.
Anti-histamines: They are effective in relieving the allergic symptoms, use of

topical or oral corticosteroids may help reduce inflammation and secretions.
Treatment
Allergic Desensitization: In patient's with seasonal allergies,desensitization
(allergy shots) may help relieving chronic symptoms.
Sinus drainage and irrigation: With clogged sinus ostia and failed drainage
system, nasal decongestant sprays to open up sinus channels are more helpful
than antihistamines and corticosteroids, and help to restore normal drainage.
Oral decongestants reduce nasal and sinus mucosal congestion and can be used
over a long period of time. Saline nasal douches are also helpful in restoring nasal
mucociliary function and in return improve sinus drainage. When medical
treatment fails, mechanical irrigation and aspiration is undertaken.
Antifungal chemotherapy: It is sometimes required especially in cases of

rhinocerebral mucormycosis or aspergillos with or without surgical removal of
disease depending on the extent of disease.
Reference
https://www.ncbi.nlm.gov
emedicine.medscape.com
https://www.ifem.cc
www.hkmacme.org
https://www.acponline.org
https://www.aae.org
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Treatment of Maxillary Sinusitis

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Treatment of maxillary sinusitis

• Multi sinusitis: If more than one sunus is infected.

Infection of sinuses that

Either acute or chronic; it starts

 Acute infectious fevers concerned with the respiratory tract or

Inflammatory sinus is first treated conservatively with medication.

Anti-histamines: They are effective in relieving the allergic symptoms, use of

Antifungal chemotherapy: It is sometimes required especially in cases of

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