Acute Etmoiditis
Transcript of Acute Etmoiditis
-
7/23/2019 Acute Etmoiditis
1/24
ACUTE ETMOIDITIS
-
7/23/2019 Acute Etmoiditis
2/24
Defnisi
Ethmoiditis adalah ineksi dari sinus-sinusethmoid, yang erentuk se!ertisarangleah terdiri dari sel-sel udara yang
erkum!ul antara ka"um nasal dan orita Akut ethmoiditis iasanya timul dari
!enyearan ineksi dari sinus-sinuslain#Ethmoiditis meru!akan kasus yang $arangdan da!at ter$adi !ada semua umur
-
7/23/2019 Acute Etmoiditis
3/24
Etiologi
Ethmoiditis sering meru!akan kom!likasi dariineksi saluran naas atasse!erti in%uen&a
'angguan drainase karena sumatan ostium
da!at $uga men$adi !enyeanya se!erti !oli!,enda asing, anormalitas anatomi )se!ertise!tumde"iasi*, tumor, imunoko!romise,trauma, gangguan letak saluran 'IT,dananormalitas dari motilitas silia mukosa
Ineksi !ada gigi $uga da!at meru!akan okalineksidan menyear terutama melalui!emuluh darah
-
7/23/2019 Acute Etmoiditis
4/24
aktor resiko untuk ter$adinyaethmoiditis
-
7/23/2019 Acute Etmoiditis
5/24
Stre!to+o++us !neumoniae
aemo!hilus in%uen&ae
Sta!hylo+o++us aureus
Stre!to+o++us !yogenes
-
7/23/2019 Acute Etmoiditis
6/24
Ethmoiditis
-
7/23/2019 Acute Etmoiditis
7/24
Signs sym!toms
.ain lo+ali&ed o"er the ridge o thenose, medial and dee! to the eye
Oedema o the li! oth eyelids e+ome
!u/y and s0ollen 1asal dis+harge on anterior rhinos+o!y,
!us may seen in the middle and su!eriormeatus de!ending on the in"ol"ement o
anterior or !osterior grou!s o ethmoidsinuses
S0elling o the middle turinate
-
7/23/2019 Acute Etmoiditis
8/24
ealthy sinuses "sin%ammation sinuses
-
7/23/2019 Acute Etmoiditis
9/24
Treatment
-
7/23/2019 Acute Etmoiditis
10/24
Treatment
2 ma3illary sinusitis
4isual disturan+e and e3o!htalmus as+ess in the !osterior orit
Drainage o the ethmoid sinuses into the
nose E3ternal ethmoide+tomy
5ess
-
7/23/2019 Acute Etmoiditis
11/24
Com!li+ation
-
7/23/2019 Acute Etmoiditis
12/24
5ungal sinusitis
Fungi are eukaryotic organismscomprising of moulds, yeasts,mushrooms and other similar
organisms. Among this group oforganisms only about 0.1% arehuman pathogens. The termmycosis is used to dene diseasescaused by fungi.
-
7/23/2019 Acute Etmoiditis
13/24
E!idemiology
Fungal infections of nose and sinusesare getting common these days. ithincreasing incidence of !"# and otherdiseases like diabetes $hich compromisehost immunity it is no $onder that theincidence of fungal infections inolingnose and para nasal sinuses is on therise. "n "ndia the incidence of fungalsinusitis in immuno competent patientsis also sho$ing a rise. This particularfact need to be studied f
-
7/23/2019 Acute Etmoiditis
14/24
Classif+ation
Acute fulminant inasie sinusitis
&hronic inasie fungal sinusitis
'ranulomatous inasie fungalsinusitis
Fungal ball
Allergic fungal rhino sinusitis
-
7/23/2019 Acute Etmoiditis
15/24
Acute fulminant invasive sinusitis: The$hole duration of illness in these
patients is (ust less than ) $eeks. Thesepatients are mostly immunocompromisedindiiduals. The reduced immunity couldery $ell be a result of
a. *iabetes mellitus
b. A"*+
c. "mmunosuppressie medicines
d. alignancy causing immunesuppression
-
7/23/2019 Acute Etmoiditis
16/24
The fungus commonly associated $iththis infection belongs to ucoraceaefamily or Aspergillus family. "f ucor isinoled then the lesion is
angioinasie and destroys both boneand soft tissue. -atients belonging tothis group hae high mortality rate./tensie surgical debridement of the
lesion $ith remoal of necrotic tissueshould be performed and must befollo$ed $ith intraenous antifungalmedication i.e. amphotericin
-
7/23/2019 Acute Etmoiditis
17/24
Chronic invasive fungal sinusitis: Thiscondition is also kno$n as ongranulomatous chronic inasie fungal
sinusitis. This condition commonly a2ictspatients $ith diabetis mellitus. This disorderis characterised by lo$ grade in3ammation$ith tissue necrosis. There is ery littleascular inasion.
'ranuloma formation $hich is common inthese patients re4uires an appropriate cellmediated immune response $hich is commonin diabetics.The duration of this disease is longer than )$eeks 5more than 6 $eeks in some cases7.
8rbital e/tension is common, causingproptosis. These patients can be managedby $ide surgical debridement, follo$ed bysystemic intraenous antifungal drugs likeamphotericin .
-
7/23/2019 Acute Etmoiditis
18/24
Granulomatous invasive fungal sinusitis:This condition is also kno$n as "ndolent
fungal sinusitis. These patients hae anintact cell mediated immune reponse.&lincially it is irtually impossible todistinguish it from non granulomatousfungal sinusitis. !istopathology $ill clinchthe diagnosis. The intact immune system of
the patient limits the inasion to thesupercial mucosa. 'ranulomas could beseen surrounding the fungal elements thuspreenting their deeper inasion. Thegranulomas could be seen surrounded by
multinulceated giant cells, eosinophils etc.+urgical debridement alone is su9cient tocure these patients. Their intact immunesystem takes oer from no$ on.
-
7/23/2019 Acute Etmoiditis
19/24
Fungal Ball: These mycetomas commonlypresent as unilateral opacication of
ma/illary or sphenoid sinus. The ethmoidsand frontal sinuses are ery rarelyinoled. These patients are usuallyimmunocompetent $ithout eidence ofatopy. The fungal ball is composed oftightly packed hyphae often fromAspergillus, Alternaria and -. boydii.Treatment is mostly surgical remoal ofthe fungal mass combined $ith
$idenening of ostium there by increasingthe entilation of the sinuses. Antifungaldrugs are not indicated in these patients.
-
7/23/2019 Acute Etmoiditis
20/24
-
7/23/2019 Acute Etmoiditis
21/24
Allergic fungal sinusitis: Thesepatients hae a combination of nasalpolyposis, crust formation associated
$ith positie sinus cultures foraspergillus. :obson 51;
-
7/23/2019 Acute Etmoiditis
22/24
ent=s criteria for the diagnosis ofallergic fungal sinusitis>1. *emonstrable type "
hypersensitiity to fungi?. asal polyposis@. :adiological ndings 5!eterodensemass lesion7
). -resence of eosinophilic mucinmi/ed $ith non inasie fungus. -ositie fungal stain B fungal culture
-
7/23/2019 Acute Etmoiditis
23/24
-
7/23/2019 Acute Etmoiditis
24/24