Bài giảng Biến chứng của viêm mũi xoang

BIẾN CHỨNG CỦA VIÊM MŨI XOANG Complicatious in Rhinosinusitis PGS.TS Nguyễn Hữu Khôi Bộ môn TMH – ĐHYD Tp HCM 2006 Complicatious in Rhinosinusitis • Preantibiotic Era: BC mắt thường xảy ra. Trong số này có 17% Meningitic, 20% Blindness. • Thời đại KS: BC ít gặp, vẫn có BC nặng / tử vong. • Điều kiện xảy ra BC: - Med.Treatment: inadequate - Host immunity: impaired. - Organisms: Virulent & resistant. - Surgical Intervention: delayed. • Mũi xoang Cận kề Viêm - Biến chứng Mắt - Não Orbital Complications • Orbit: close proximity to the sinus Medially: Ethmoid & Sphenoid Sinus. Superiorly: Frontal. Inferiorly: Maxillary. • Prevalent: Children  > Aldults • VX gây BC: 1st Ethmoid Simusittis  2st Frontal / Maxillary 3st Sfhenoid ± Orbital Complications Thành ngoài xoang sàng xương giấy và thành ngoài xoang bướm ngăn cách với ổ mắt: rất dễ bị tổn thương gây biến chứng cho ổ mắt và dây thần kinh thị giác ORBITAL EXTENSION OF SINUSITIS Two routes 1. Direct Extension - Through emgenital body dehischices. open suture liues / foramina. - By erosion of the bony barrier. Lamina papyracea 2. Retrograde Thromb phlebitis. • Rich network of valveless veines. ( face, nasalcarity, Sinus = orbit) • Arterial spread: possible / imlikely. • Lymphatics: absent in the orbit. ORBITAL COMPLICATIONS OF SINUSITIS 1. Periorbital Cellulitis. Inflammatory Edema of the Eyelid. 2. Orbital Cellulitis. Inf. & Edema of orbital Conthits. 3. Subperiosteal Abscess: Collection of pus between periorbi & bony orbital wall. 4. Orb. Abscess: Collection of pus in the Orb. 5. Cavernous sinus Thrombosis. 6. Loss of Vision. ORBITAL CELLULITIS • Diffuse Inflammation & Edema. of the orbital Contents without Abscess. • Proptosis, chemosis, ophthalmoplegia. chemosis: conjunctival Edema. ( Secondary, obstruction of oph. Veines ) • Untreated  Abscess & Blindness. SUBPERIOSTEAL ABSCESS • Collection of pus:Orb. Periosteum//bony orb.wall • Orbital contents: displaced in ferolaterally. Chemosis, ocular Mobility  • Abscess penetrate: Laterally  Orbit Anteriorly  Eyelid ORBITAL ABSCESS • Collection of Pus in the orbital Tissue. Extraconal: Periosteum // Muscle in traconal, centrally within the musle cone • Mecanism - Result of progoenion of orb. Cellulitis. - Spread of infection from subperiosteal abscess. • Symptoms: Proptosis, visual loss Limitation of extraocular Movement CAVERNOUS SINUS THROMBOSIS • Source of Infection: Ethmoid, sphenoid/often • Direct extension / Retrograd thrombophlebitis • Early symptoms: Fever, Headach, Photophobia Diplopia, periorbital Edema. • Classic findings: Ptosis, Proptosis, Chemosis ocular palsy, Visual Acuity  • Hallmark of CST: Bilateral ocular symptoms •  Neve II – VI, Pituitany, Meningitis cerebral abscess LOSS OF VISION 1. Temporary or permanent ± funduscopic abnormalities. 2. Pathophysiology of decreased Vision. • Ischemic optic neuropathy. • Compressive optic neuropathy ( ethmoiditis ) • Inflammatory optic neuropathy. INTRACRANIAL COMPLICATIONS • Acute Sinusitic or acute exacerbation of CS • Frontal: most common  ethmoid, sphenoid, maxillary • Antibiotics: not changed the incidence of Sinusitis decreased the frequency of complications • Most serious intracranial complications: Osteomyelitis, Epidural Abscess, Subdural Empyema Superior sagittal Sinus & Cavernous S. Thrombosis Meningitis & Intracranial Abscess