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Paranasal sinuses

The adnexal sinuses are the airway cavities in some bones of the facial skull, communicating with the nasal cavity through narrow channels or cracks (Figures 1 and 2).


Fig. 1. The outer, or lateral, wall of the nasal cavity (nasal sinks removed): 1 - the frontal sinus; 2 - openings of the posterior cells of the ethmoid bone; 3 - the hole of the main sinus; 4 - cut line of the middle shell; 5 - cut line of the lower shell; 6 - opening of the maxillary sinus; 7 - openings of the front cells of the ethmoid bone. Fig. 2. Diagram of the relationship of the paranasal sinuses (side view): 1 - maxillary sinus; 2 - the main sinus; 3 - cells of the ethmoid labyrinth; 4 - frontal sinus.

Anatomy . The maxillary, or maxillary, sinus is located in the body of the maxillary bone. The hole connecting the maxillary sinus with the nasal cavity, is in the middle of the nasal passage. The frontal sinus is located between the plates of the orbital part and the scales of the frontal bone. It communicates with the nasal cavity through the fronto-nasal canal, which opens in front of the middle nasal passage.

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Latticar maze consists of 2-5 or more different in size and shape of air-bearing cells. The anterior cells open in the middle nasal passage, and the posterior - in the upper. The main, or wedge-shaped, sinus is located in the body of the main bone, directly behind the ethmoid labyrinth. On the front wall in each half of the sinus is located on the hole, which communicate the sinuses with the nasal cavity. The mucous membrane of the paranasal sinuses is similar in structure to the mucous membrane of the nasal cavity, but only much thinner than it and relatively poorer in blood vessels and glands.

Research methods : in addition to anamnesis, the examination includes external examination and palpation of the sinus area, anterior and posterior rhinoscopy , sounding through the openings opening into the nasal cavity, diaphanoscopy (see), x-ray examination , test puncture and washing of the maxillary sinus.

Damage to the paranasal sinuses can occur with a closed injury (blow, fall, jerk, compression) and with injuries. Gunshot wounds of the paranasal sinuses are isolated, but are often combined with wounds of the nasal cavity, upper or lower jaw, oral cavity, upper pharynx and orbit. In the sagittal direction of the wound channel, a through wound often leads to the death of the wounded as a result of damage to the cranial cavity and its contents.

Treatment . In fresh cases of injuries, stop bleeding and primary treatment of the wound . For all injuries, a prophylactic dose of tetanus toxoid is required.

Diseases . Acute and chronic inflammation. Acute inflammations of the paranasal sinuses ( sinusitis ) often complicate the course of influenza, acute rhinitis , measles, scarlet fever and other infectious diseases.

Acute sinusitis can be catarrhal and purulent, chronic - purulent, catarrhal (edematous-polyposis) or mixed.

Symptoms Common symptoms (fever, headache, feeling unwell) are observed during acute or exacerbation of chronic inflammation of the paranasal sinuses. Patients complain of abundant fluid or thick discharge from the nose and its laying, often on the one hand.

The diagnosis of inflammation of the paranasal sinuses is made on the basis of the patient's complaints, anamnesis and an objective examination of the nasal cavity. Additional research methods (diaphanoscopy, X-ray , sensing) allow to clarify the diagnosis of inflammation of the paranasal sinuses.

Inflammatory diseases of individual sinuses - see. Aerosinusitis, Sinusitis , Sphenoiditis , Frontitis , Etmoiditis .

Pansinusitis is a simultaneous inflammatory disease of all the paranasal sinuses on one or both sides. Symptoms of pansinusitis consist of the effects of damage to the corresponding sinuses.

Treatment in acute cases is conservative, in chronic - surgical.

Patients with fever need bed rest. Antipyretic drugs are used (acetylsalicylic acid 0.5 g, caffeine 0.1 g) one powder 2-3 times a day. To reduce the swelling of the nasal mucosa, especially in the area of ​​the orifices of the paranasal sinuses, and to facilitate the outflow of contents from the sinuses, lubricate the middle nasal passage with a 1-2% solution of cocaine with a 3% solution of ephedrine or pouring drops into the nose — a 2-3% solution of ephedrine or cocaine . It is better to pour drops into the nose in the horizontal position of the patient. His head should be somewhat upturned and slightly turned in the painful direction, so that the drops fall into the middle and upper nasal passages.

Allergic rhinosinusopathy - a manifestation of allergy in the paranasal sinuses - can be isolated or in combination with other allergic diseases (bronchial asthma, eczema , urticaria, etc.). Acute attack of an allergic sinusopathy usually begins suddenly with itching and stuffiness of the nose, heaviness in the head and abundant watery discharge ( transudate ).

With a rhinoscope, you usually see a swollen mucous membrane of a white or pale-lilac shade. The disease flows for a long time.

Treatment - vasoconstrictive drops in the nose, antihistamines (diphenhydramine, pipolfen), calcium preparations, corticosteroids, vitamins.

Mukotsele occurs when closing the openings of the paranasal sinuses and stretching their bone walls accumulate in the sinus contents. Often affects the frontal sinus and ethmoid labyrinth. Mucocele often leads to protrusion of the eye and deviation of it outwards.

The treatment is surgical.

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Sinus paranasales - airway cavities adjacent to the nasal cavity and communicating with it through narrow channels or cracks.

Anatomy . On each side of the nasal cavity adjacent maxillary (maxillary), or maxillary, sinus, frontal sinus, ethmoid labyrinth, and partly the main sinus.

The maxillary, or maxillary, sinus (sinus maxillaris, s. Antrum Highmori) is located in the thickness of the maxillary bone. In newborns, the maxillary sinus has the appearance of a narrow slit, it increases with age and reaches full development by the age of 15-20. This is the largest of all the paranasal sinuses; its capacity in an adult is from 3 to 30 cm 3 , on average 10-12 cm 3 . The shape of the maxillary sinus resembles a triangular pyramid, the base of which is located on the side wall of the nasal cavity, and the apex - in the zygomatic process of the upper jaw. The front wall is anteriorly facing, the superior or orbital wall separates the maxillary sinus from the orbit, and the posterior one faces the inferior and the wing-palatal fossae. The opening connecting the maxillary sinus with the nasal cavity (hiatus maxillaris) is in the middle nasal passage.

The frontal sinus (sinus frontalis) is located between the plates of the orbital part and the scales of the frontal bone. The frontal sinus in the newborn is still absent; its development begins with the first year of life and usually ends by the age of 25. It distinguishes the lower or orbital, anterior, or facial, posterior, or brain, and middle walls. The average capacity of the frontal sinus is 3-5 cm 3 . The frontal sinus communicates with the nasal cavity through the fronto-nasal canal (apertura sinus frontalis), which opens in front of the middle nasal passage.

The lattice labyrinth (labyrinthus ethmoidalis) consists of 2–5 or more air cells (cellulae ethmoidales) of different size and shape, which are delimited from the anterior cranial fossa by the orbital part of the frontal bone and sieve plate of the ethmoid bone, and from the orbit - by the orbital (paper) plate (lamina orbitalis). The airborne cells of the ethmoid labyrinth of a newborn are a series of narrow pockets; they develop relatively faster than all other paranasal sinuses. The anterior cells open in the middle nasal passage, and the posterior - in the upper.

The sinus sphenoidalis (sinus sphenoidalis) is located in the body of the main bone directly behind the latticed maze above the choana and the nasopharynx arch. The sagittal septum (septum sinuum sphenoidalium) of the sinus is divided into two in most cases, parts that are not identical in volume. On the front, the thinnest wall in each half of the sinus is a hole (apertura sinus sphenoidalis). The development of the main sinus begins only after birth and ends at about 20 years.

The mucous membrane of the paranasal sinuses in its structure differs little from the mucous membrane of the nasal cavity (see). It is much thinner and relatively poorer in blood vessels and glands than the mucous membrane of the nasal cavity.

Blood supply to the paranasal sinuses comes from the branches of the internal and external carotid arteries, mainly through the orbital, external and internal maxillary arteries. The veins of the maxillary sinus anastomose with the veins of the face and pterygoid plexus, and the veins of the frontal sinus with the veins of the dura mater, with the longitudinal sinus and cavernous sinus. In these ways, the infection sometimes penetrates the orbit or the cavity of the skull. The innervation of the paranasal sinuses is carried out from the first and second branches of the trigeminal nerve, as well as from the wing-palatal node.

Examination of the paranasal sinuses, in addition to anamnesis, includes external examination and palpation, anterior and posterior rhinoscopy (see), probing, diaphanoscopy (see), x-ray, test puncture and washing the maxillary sinus.

X-ray examination allows you to judge the size and shape of the paranasal sinuses, as well as the presence of pathological formations (see below X-ray diagnosis of diseases of the paranasal sinuses). For this purpose, X-rays are taken in straight, axial and lateral projections. The pathological condition of the paranasal sinuses - loss of transparency - is determined by the symptom of darkening on the radiograph. A necessary condition for the study is the comparison of radiographic data with the clinical picture.

Fig. 1. Severe asymmetry of the maxillary sinuses.

Anomalies of development . The absence of the maxillary sinuses is an extremely rare phenomenon. Their asymmetry occurs much more frequently (Fig. 1). Sometimes there is a lack of frontal sinuses (one or both).

Asymmetry of the frontal sinuses is observed more often than the maxillary; bony septum at the same time can be significantly shifted in one direction or another. Strong pneumatization of the sinus with the formation of deep coils in the presence of unpleasant subjective sensations, some authors refer to the pathology (the so-called pneumo). The main sinus may remain in its infancy or absent altogether. Anomaly of the main sinus is bone dehiscence on its lateral walls. In these cases, the mucous membrane of the sinus can come into contact with the dura mater of the middle cranial fossa, the region of the internal carotid artery, the cavernous sinus, optic nerve, the upper orbital fissure, and the wing-palatal fossa.

Damage to the paranasal sinuses can occur with a closed injury (blow, fall, jerk, compression) and with injuries.

Gunshot wounds of the paranasal sinuses are isolated, but are often combined with wounds of the nasal cavity, upper or lower jaw, oral cavity, upper pharynx and orbit. In the sagittal direction of the wound channel, through wounds often lead to the death of the wounded as a result of damage to the cranial cavity and its contents. With the transverse, or frontal, direction of the wound channel, lesions of vital formations rarely occur, therefore, the prognosis for such injuries is often favorable. Injuries to the paranasal sinuses in most cases are complicated by the inflammatory process, which can occur in the form of purulent or proliferative sinus. Fragments of shells, fragments of bones that are in the sinuses, support the inflammatory process and delay recovery.

The general condition of the wounded man with the superficial wounds of the paranasal sinuses suffers little; with deeper (especially with wounds in the region of the base of the skull) loss of consciousness and a short-term shock condition are often observed. Inflammatory processes in the paranasal sinuses usually occur at elevated temperature (37.5-38 °), which gradually decreases to normal or subfebrile. The increase in temperature to 39-40 ° and the deterioration of the general condition may indicate the occurrence of complications in the areas bordering the paranasal sinuses in the form of phlegmon, purulent blisters, thrombophlebitis or a septic condition, pneumonia. When wounds of the frontal sinus and the lattice labyrinth should be aware of the possibility of damage to the substance of the brain and its membranes; if an intracranial complication is suspected, surgery should be undertaken as soon as possible.

In the diagnosis of gunshot wounds, it is necessary to accurately determine the type of injury and the direction of the wound channel at the point of entry and exit of the injuring projectile. X-ray examination is very important. Because of the danger of the spread of infection, careless sensing should be avoided in fresh cases of injuries of the paranasal sinuses, as well as probing of fistulas that are directed upwards - into the area of ​​the ethmoid labyrinth, the main and frontal sinuses. A reliable sign of a fracture of the walls of the paranasal sinuses with a simultaneous rupture of the mucous membrane lining it is the emphysema of the face (especially the forehead) or the orbit. Emphysema can occur even with light, limited damage to the sinuses of the paranasal sinuses and spread far beyond them, seizing the entire face, neck and chest and assuming a threatening character.

Treatment. With closed injuries affecting only the outer walls of the frontal, maxillary and ethmoid sinuses (which becomes clear from radiographs in various projections), sometimes you can wait with surgical intervention. The development of suppuration is an indication for immediate surgery. If you suspect a fracture or other damage to the posterior cerebral walls of the paranasal sinuses, an urgent operation is also shown. In the fresh cases of injuries of the paranasal sinuses, the bleeding is stopped and the wound is first treated. For all injuries, a prophylactic dose of tetanus toxoid is required. During the initial processing, surface foreign objects are removed. More deeply located metal foreign bodies from the paranasal sinuses and the areas nearest to them are removed by specialists, depending on the evidence. With the preventive purpose against possible intracranial and septic complications, sulfa drugs and antibiotics are prescribed.