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Chronic sinusitis

Chronic sinusitis. Definition. Inflammation of the mucosa of one or more paranasal sinuses lasting for more than 3 months. Etiology. Mechanial obstruction Infections Trauma Decreased mucociliary function Allergy. Pathophysiology. Pathology.

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Chronic sinusitis

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  1. Chronic sinusitis

  2. Definition • Inflammation of the mucosa of one or more paranasal sinuses lasting for more than 3 months

  3. Etiology • Mechanial obstruction • Infections • Trauma • Decreased mucociliary function • Allergy

  4. Pathophysiology

  5. Pathology • Surface epithelium- desquamation or metapalsia • Submucosa – lymphocytes, plasma cells, fibrosis, polyp

  6. Symptoms of CRS • 4 major symptoms ( 2 , to make Dx ) • Purulent nasal discharge • nasal obstruction or blockage • facial pain, pressure, and/or fullness • decreased sense of smell J Allergy ClinImmunol 2010;125:S103-15

  7. Symptoms of CRS • Minor symptoms:   •    Headache •    Fever •    Halitosis •    Fatigue •    Dental pain •    Cough •    Ear pain/pressure/fullness Middleton’s Allergy,principal & practice. Seventh edition.

  8. Diagnosis

  9. Diagnosis

  10. Treatment - medical • Correct the underlying cause • Antibiotics • Decongestants • Antihistaminics

  11. Surgical management

  12. Surgery for maxillary sinusitis • Antral puncture • Intranasal antrostomy • Caldwell luc surgery • FESS

  13. Antral puncture

  14. Intranasal antrostomy

  15. Caldwell luc surgery

  16. Suction of maxillary sinus

  17. Surgeries for chronic frontal sinusitis • Frontal sinus trephination • External frontoethmoidectomy • Osteoplastic flap operation • FESS

  18. Frontal sinus trephination

  19. External frontoethmoidectomy

  20. Surgeries for ethmoid sinusitis • Intranasal ethmoidectomy • External ethmoidectomy

  21. External ethmoidectomy approach

  22. F.E.S.S.

  23. Steps of F.E.S.S. 1.Uncinectomy (Infundibulotomy) 2. Anterior ethmoidectomy 3. Middle meatalantrostomy 4. Perforation of basal lamella 5. Posterior ethmoidectomy 6. Sphenoid sinus exploration 7. Frontal recess exploration

  24. Left middle meatus

  25. Incision on uncinate process

  26. Uncinate process removed

  27. Opening made on basal lamella

  28. Interior of sphenoid sinus

  29. THANK YOU

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