1. PARANASAL SINUSES Anatomy, Physiology and Diseases
Maria Angelica M. Geronimo
Group 5a

2. PARANASAL SINUSES
Air-filled cavities that communicate with the nasal cavities

3. PARANASAL SINUSES Anatomy

4. NASAL CAVITY Anterior Ethmoid cells Frontal Sinus Maxillary Sinus
Middle Meatus
NASAL CAVITY
Posterior Ethmoid cells
Superior Meatus
NASAL CAVITY

5. MAXILLARY SINUS Medial: nasal cavity
Floor: close to the root of the second premolar and first molar teeth
Posterior: Pterygopalatine fossa
Traversed by the maxillary artery, branches of the CN V and ANS

6. ETHMOID AIR CELLS
Labyrinthine system of small, pneumatized sinus cavities
Posterior: close to CN II
Lamina papyracea
Orbital plate
Forms the lateral bony wall that separates it from the orbit

7. SPHENOID SINUS Center of the skull above the nasopharynx
Clivus - forms the posterior wall
Superior: sella turcica + pituitary, and anterior and middle cranial fossae
Lateral: cavernous sinus, ICA and CN II-VI
Closely related to CN II

8. FRONTAL SINUS Floor: forms the medial portion of the orbital roof
Anterior: anterior cranial fossa

9. PARANASAL SINUSES Physiology

10. Functions Humidification Vocal resonance Mucus production
Increased olfactory area
Absorbs shock to the head
Regulation of intranasal pressure

11. PARANASAL SINUSES Diseases

12. Sinus Inflammation
Acute
Chronic

13. MAXILLARY SINUSITIS Predisposing factors Symptoms Signs Organism
Mild URTI
Nasal allergies
Foreign bodies
Deviated nasal septum
Symptoms
Fever, vague headache relieved by analgesics, malaise
Fullness of the face, pain in the teeth esp. upon going up and down the stairs
Dull, throbbing cheek pain
Signs
Tenderness to pressure and percussion
Foul, mucopurulent secretions
Decreased transillumination
Water’s view- mucosal thickening and opacification of the maxillary sinuses
Organism
Streptococcus pneumoniae, H. Influenzae, anaerobes, Branhamella Catarrhalis
Treatment
Antibiotics, decogestants, analgesics

14. ETHMOID SINUSITIS Prevalence Symptoms Treatment
Children: orbital cellulitis
Adults: accompanies maxillary sinusitis
Symptoms
Pain and tenderness between the eyes and over the bridge of the nose
Thick nasal secretions
Nasal obstruction
Treatment
Antibiotics, nasal decongestants, analgesics, nasal sprays

15. FRONTAL SINUSITIS Prevalence Symptoms Treatment
Associated with anterior ethmoditis
Predominantly in adults
Symptoms
Pain is above the eyebrows usually in the AM, worse at midday, gradually lessens at the end of the day
Forehead may be tender to touch and may have supra orbital swelling
Treatment
Antibiotics, decongestants, vasoconstrictor nasal sprays

16. SPHENOID SINUSITIS Prevalence Symptoms Treatment
Associated with other sinusitis
Not very common
Symptoms
Headache directed to the vertex of the skull
Treatment
Antibiotics, decongestants, vasoconstrictor nasal sprays

17. PARANASAL SINUSES Complications

18. Orbital Complications Orbital Cellulitis Abscess Subperiosteal abscess
Orbital abscess
Cavernous Sinus Thrombosis

19. MUCOCOELE Mucus containing cyst found in the sinuses
Frequently seen in the maxillary sinuses (mucus retention cysts)
Ethmoids or frontal sinuses: swelling in the forehead
Sphenoids sinus: diplopia or impaired vision

20. PYOCOELE Similar to a mucocoele but contains pus
Treatment: surgical removal and re-establishment of a good drainage

21. ACUTE MENINGITIS
Infections may spread through venous channels or directly from neighboring sinuses such as posterior wall of the frontal sinus
Fever, chills, nausea, vomiting, signs of meningeal irritation

22. DURAL ABSCESS
Collection of pus between dura and internal table of the skull usually seen in frontal sinusitis
Intractable headache, spiking fever, may have signs of meningeal irritation
Increased ICP

23. BRAIN ABSCESS Occurs through directly extending thrombophlebitis
Brain may be contaminated at the peak of a severe suppurative sinusitis
Chills and fever, lack of appetite, weight loss, nausea and vomiting
Treatment: Massive IV antibiotics, surgical drainage

24. OSTEOMYELITIS Commonly seen in frontal sinusitis
Erosion of the frontal bone
Localized forehead pain, fever, chills, swelling over brow area
Radiographs: “moth-eaten” appearance of the margins of the sinuses