Chronic sinusitis (慢性鼻竇炎)

Frontal sinusitis

Clinical features:

Presents as a persistent frontal headache or, if a mucocele develops, a unilateral proptosis. A pyocele may result from secondary infection of a mucocele. X-rays show an opaque sinus, often with hazy, indistinct edges. A CT scan will show a soft tissue mass filling the sinus.

Management:

Surgical treatment is aimed at re-establishing aeration of the frontal sinus. The area of the frontal recess leading into the frontal sinus can be approached either endoscopically through the nasal cavity or via an external incision. Obliteration of the frontal sinus via an osteoplastic flap approach is a radical procedure very rarely required.

Maxillary sinusitis

Aetiology:

Disease is commonly bilateral unless there is an underlying septal deviation, unilateral polyp or history of maxillary trauma. A past history of dental treatment may be relevant.

Clinical features:

Usually presents with chronic facial pain or upper jaw toothache. Other presentations include a purulent postnasal drip, chronic laryngitis or otitis media. Examination is often normal but paranasal sinus X-rays usually demonstrate antral disease, in the form of mucosal thickening, a persistent fluid level or total opacification.

Management:

Treatment involves the creation of intranasal antrostomies to ventilate and drain the antra. Antrostomies are now normally performed endoscopically through the middle meatus. In severe cases a Caldwell-Luc approach can be used to remove diseased antral mucosa.