Sinusitis
According to the duration of the disease, rhinosinusitis is divided into two categories: acute and chronic. Acute rhinosinusitis (ARS) is defined as sudden onset of symptoms for less than 12 weeks with symptom-free intervals (complete resolution of sympto
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Chapter 2 Nose
2.5 Sinusitis According to the duration of the disease, sinusitis is divided into two categories: acute and chronic. Acute rhinosinusitis (ARS) is defined as the sudden onset of symptoms lasting less than 12 weeks (with sypmtom free intervals-complete resolution of symptoms, if the problem is recurrent). ARS can occur once or more than once in a defined time period. This is usually expressed as episodes/year, but
there must be complete resolution of symptoms between episodes for it to constitute recurrent ARS. Chronic rhinosinusitis (CRS) is defined as disease lasting more than 12 weeks without complete resolution of symptoms. CRS may also be subject to exacerbations. The presence of polypoid degeneration in the maxillary sinus deserves special attention. If the polyp is on the floor of the antrum, dental disease should be suspected. If the polyp is on the roof of the antrum, carcinoma should be ruled out in elderly patients. Any evidence of bone erosion should raise the possibility of carcinoma. In patients over 40 years of age, the possibility of carcinoma should always be kept in mind and intrasinus exploration should be performed if necessary.
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Fig. 2.5.2 Ostiomeatal complex area (OMC) (blue). The frontal, maxillary, and anterior ethmoidal cells drain to the OMC. It is a narrow area. Any edema may cause contact of the mucosal surfaces, which may lead to impaired mucociliary activity
Fig. 2.5.1 Developmental anatomy of the ethmoidal, frontal, and maxillary sinuses (a) and sphenoidal sinus (b). The ethmoidal and maxillary sinuses are present at birth. The sphenoidal sinus is in the form of a small invagination and develops later. The frontal sinus develops from the anterior ethmoidal cells and moves from an infraorbital position to a supraorbital position, starting to develop at the age of 7. Yellow, 6 months; red, 1 year; green, 3 years; blue, 8 years; maroon, 12 years of age, adult size
2.5 Sinusitis
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E A R N O S E T H R O AT A N D N E C K
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Fig. 2.5.3 (a) Maxillary sinus ostium from nasal side, (b) OMC lateral to the middle turbinate. Superior and posterior to the middle turbinate, the superior turbinate and sphenoid sinus ostium are seen;
Fig. 2.5.4 Maxillary sinus ostium from the maxillary sinus side. Mucociliary activity is toward the ostium
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(c) superior turbinate. Lateral to the superior turbinate are the posterior ethmoidal cells, and medial to the superior turbinate is the sphenoidal sinus ostium
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Chapter 2 Nose
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Fig. 2.5.5 Nasal discharge. (a) Mucoid drainage after common cold; (b) purulent drainage in the inferior meatus; (c) postnasal purulent drainage; (d) allergic mucin: viscid, thick yellow–green drainage, generally eosinophilic
2.5 Sinusitis
Fig. 2.5.6 Waters view showing right acute maxillary sinusitis. There is an air–fluid level in the right maxillary sinus
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Fig. 2.5.8 (a) Coronal CT shows bilateral maxillary sinusitis; (b) 15 days after starting medical treatment the sinuses appear to be normal
Fig. 2.5.
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