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Orbital Complications• Orbit: close proximity to the sinus Medially: Ethmoid & Sphenoid Sinus... & Edema of orbital Conthits.. Subperiosteal Abscess: Collection of pus between periorbi

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: 1 st Ethmoid Simusittis 

2 st Frontal / Maxillary

3 st Sfhenoid ±

Orbital Complications

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