sinusitis paranasalis
DESCRIPTION
1TRANSCRIPT
![Page 1: Sinusitis Paranasalis](https://reader036.vdocuments.site/reader036/viewer/2022081501/55cf9cec550346d033ab8b1f/html5/thumbnails/1.jpg)
SINUSSITIS PARANASALIS (SP)
SP :- Tidak jarang
- Akibat gangguan drenasi + ventilasi SPN
Messerklinger – kelainan/infeksi KOM
hilangkan/fungsionalisasi
SP sembuh/tidak kambuh ( dasar BSEF / FESS )
- Satu sinus – multiple – pan sinussitis uni- bilateral
- Menurut perlangsungan :
SP akut – (sub akut) – kronik
![Page 2: Sinusitis Paranasalis](https://reader036.vdocuments.site/reader036/viewer/2022081501/55cf9cec550346d033ab8b1f/html5/thumbnails/2.jpg)
Sinus Paranasal Anterior
![Page 3: Sinusitis Paranasalis](https://reader036.vdocuments.site/reader036/viewer/2022081501/55cf9cec550346d033ab8b1f/html5/thumbnails/3.jpg)
Sinus paranasal posterior
![Page 4: Sinusitis Paranasalis](https://reader036.vdocuments.site/reader036/viewer/2022081501/55cf9cec550346d033ab8b1f/html5/thumbnails/4.jpg)
SP AKUT
ETIOLOGI :
Rhinitis akut ( rhinogen )
Infeksi faring
Infeksi gigi (dentogen)
Renang / selam
Trauma maxillo-facial ( langsung )
Barotrauma – aerosinussitis
Benda asing hidung
ETIOLOGI :
Rhinitis akut ( rhinogen )
Infeksi faring
Infeksi gigi (dentogen)
Renang / selam
Trauma maxillo-facial ( langsung )
Barotrauma – aerosinussitis
Benda asing hidung
![Page 5: Sinusitis Paranasalis](https://reader036.vdocuments.site/reader036/viewer/2022081501/55cf9cec550346d033ab8b1f/html5/thumbnails/5.jpg)
SP AKUT
![Page 6: Sinusitis Paranasalis](https://reader036.vdocuments.site/reader036/viewer/2022081501/55cf9cec550346d033ab8b1f/html5/thumbnails/6.jpg)
SP AKUT
FAKTOR PREDISPOSISI :
Lokal : - Obstruksi nasi
- Sumber infeksi
- Rekurensi
Sistemik : - Alergi
- Iklim – atmosfir ekstrim
- Keletihan
- Malnutrisi – penyakit kronik
![Page 7: Sinusitis Paranasalis](https://reader036.vdocuments.site/reader036/viewer/2022081501/55cf9cec550346d033ab8b1f/html5/thumbnails/7.jpg)
SP AKUT
• BAKTERIOLOGI :
Pneumococcus, Staphylococcus, H. influenzae
( tidak tetap )
• PATOLOGI :
Udema, hiperemia, hiperskresi, infiltrasi sel radang dan exudasi
![Page 8: Sinusitis Paranasalis](https://reader036.vdocuments.site/reader036/viewer/2022081501/55cf9cec550346d033ab8b1f/html5/thumbnails/8.jpg)
SP AKUT
GAMBARAN KLINIK :
Nyeri sinus
Rinore – “Post Nasal Dripping”
Kental – “Blood stained”
Obstruksi nasi
Cephalalgia
Gejala umum
Gejala obyektif setiap sinus
![Page 9: Sinusitis Paranasalis](https://reader036.vdocuments.site/reader036/viewer/2022081501/55cf9cec550346d033ab8b1f/html5/thumbnails/9.jpg)
SP AKUT
• DIFFERENTIAL DIAGNOSIS :- Nyeri gigi - Migraine- Trigeminal neuralgia - Neoplasma SPN- “Insect bite” - Erysipelas
• DIAGNOSIS : Anamnesis Pemeriksaan : - RA + RP
- Transiluminasi - X–foto SPN - CT–Scan / MRI
![Page 10: Sinusitis Paranasalis](https://reader036.vdocuments.site/reader036/viewer/2022081501/55cf9cec550346d033ab8b1f/html5/thumbnails/10.jpg)
![Page 11: Sinusitis Paranasalis](https://reader036.vdocuments.site/reader036/viewer/2022081501/55cf9cec550346d033ab8b1f/html5/thumbnails/11.jpg)
SP AKUT
TERAPI :
Perbaiki drenasi-ventilasi SPN
(decongestan-infraksi)
Atasi infeksi
Atasi nyeri + penenang
Berulang BSEF
![Page 12: Sinusitis Paranasalis](https://reader036.vdocuments.site/reader036/viewer/2022081501/55cf9cec550346d033ab8b1f/html5/thumbnails/12.jpg)
SP KRONIK
• Hubungan erat rhinitis alergi + vasomotor 2/3 kasus “Chronic allergic/Vasomotor rhinosinussitis”
• Terapi optimal ingat faktor iniSP kronik tipe I : “Simple chronic infective sinussitis”SP kronik tipe II :“Mixed infective allergic vasomotor chronic sinussitis”
![Page 13: Sinusitis Paranasalis](https://reader036.vdocuments.site/reader036/viewer/2022081501/55cf9cec550346d033ab8b1f/html5/thumbnails/13.jpg)
Tipe I Alergi + Vasomotor Instability
• ETIOLOGI : - Serangan akut - Rekurensi akut kronik
• PATOLOGI :Penebalan mukosa, polip, infiltrasi sel radang kronik, metaplasi epitel, fibrosis, mikroabses, cyste – mukokel dan granulasi
• BAKTERIOLOGI :- Kuman aerob
bervariasi- Kuman anaerob
![Page 14: Sinusitis Paranasalis](https://reader036.vdocuments.site/reader036/viewer/2022081501/55cf9cec550346d033ab8b1f/html5/thumbnails/14.jpg)
Tipe I Alergi + Vasomotor Instability
GAMBARAN KLINIK :
- Rinore “post nasal dripping” purulen-mukoid- Obstruksi nasi- Hiposmia – anosmia – cacosmia- Cephalalgia (rasa berat)- Gejala umum – batuk – occlusio tubae- Gejala obyektif setiap sinus
![Page 15: Sinusitis Paranasalis](https://reader036.vdocuments.site/reader036/viewer/2022081501/55cf9cec550346d033ab8b1f/html5/thumbnails/15.jpg)
Tipe I Alergi + Vasomotor Instability
PENGOBATAN :
- Prinsip sama SP Akut perbaiki drenasi -
ventilasi SPN
- Konservatif : infraksi, punksi/irigasi, IMA
- Radikal (konvensional/”external approach”)
- Ideal BSEF
![Page 16: Sinusitis Paranasalis](https://reader036.vdocuments.site/reader036/viewer/2022081501/55cf9cec550346d033ab8b1f/html5/thumbnails/16.jpg)
Tipe II
Sama SP kronik tipe I ada faktor alergi + “vasomotor instability” pengaruhi perjalanan, derajat dan prognosis !
Sering multi-pan sinussitis & bilateral !Patologi mirip tipe I dengan kelainan > jelas !Gambaran Klinik :
- Cenderung multi-pan-bilateral SP !- Rinore + “post nasal discharge”- Hiposmia – anosmia- Gejala alergi – vasomotor menonjol !
![Page 17: Sinusitis Paranasalis](https://reader036.vdocuments.site/reader036/viewer/2022081501/55cf9cec550346d033ab8b1f/html5/thumbnails/17.jpg)
TIPE II
• TERAPI : Tanggulangi alergi - ”vasomotor instability” Tanggulangi infeksi Operasi : - Konvensional simple – radikal – external
- BSEF• PROGNOSIS :
Terapi sering tidak memuaskan ( alergi sulit tuntas )
![Page 18: Sinusitis Paranasalis](https://reader036.vdocuments.site/reader036/viewer/2022081501/55cf9cec550346d033ab8b1f/html5/thumbnails/18.jpg)
SINUSSITIS MAXILLARIS AKUT
• Tersering
• PATHOGENESIS :
- Rinogen
- Dentogen
- Langsung
- Hematogen/limfogen (jarang)
![Page 19: Sinusitis Paranasalis](https://reader036.vdocuments.site/reader036/viewer/2022081501/55cf9cec550346d033ab8b1f/html5/thumbnails/19.jpg)
SINUSSITIS MAXILLARIS AKUT
GAMBARAN KLINIK :
- Nyeri pipi – ke frontal, temporal, gigi
- Rinore – “post nasal dripping”
- Udema pipi (jarang)
- RA : - Concha media – meatus nasi media
hiperemis
- “POSTURE test” bisa positif
- Palpasi, traniluminasi, X-foto SPN, CT-Scan
![Page 20: Sinusitis Paranasalis](https://reader036.vdocuments.site/reader036/viewer/2022081501/55cf9cec550346d033ab8b1f/html5/thumbnails/20.jpg)
SINUSSITIS MAXILLARIS AKUT
• DIFFERENTIAL DIAGNOSIS :- Abses geligi atas- Trigeminal neuralgia (cabang II)- Tumor maxilla-sinus maxillaris
• TERAPI :- Prinsip sama SP + infra red, infraksi, IMA- Berulang BSEF ( “medial meatal
anthrostomy” )
![Page 21: Sinusitis Paranasalis](https://reader036.vdocuments.site/reader036/viewer/2022081501/55cf9cec550346d033ab8b1f/html5/thumbnails/21.jpg)
SINUSSITIS MAXILLARIS AKUT DENTOGEN
• Negara maju 10% SP
• Indonesia ? > banyak caries • Dewasa - jarang pada anak !
• Sumber infeksi :
- Peri-apical abses P,M
- Pasca extraksi P,M
- Periodontal abses ( tersering )
![Page 22: Sinusitis Paranasalis](https://reader036.vdocuments.site/reader036/viewer/2022081501/55cf9cec550346d033ab8b1f/html5/thumbnails/22.jpg)
SINUSSITIS MAXILLARIS AKUT DENTOGEN
TERAPI :
Hilangkan sumber infeksi
Punksi - irigasi - anthrostomi - BSEF
Antibiotik
![Page 23: Sinusitis Paranasalis](https://reader036.vdocuments.site/reader036/viewer/2022081501/55cf9cec550346d033ab8b1f/html5/thumbnails/23.jpg)
SINUSSITIS MAXILLARIS KRONIK
• Etiologi + Gambaran Klinik :
Mirip beda perlangsungan, derajat gejala dan terapi
• Penanggulangan :
- Punksi-irigasi --- IMA --- Radikal / CWL
- Ideal BSEF
![Page 24: Sinusitis Paranasalis](https://reader036.vdocuments.site/reader036/viewer/2022081501/55cf9cec550346d033ab8b1f/html5/thumbnails/24.jpg)
SINUSSITIS FRONTALIS
SF AKUT
- Amat jarang ( perkembangan lambat dan
ostium di dasar )
- Perlu penanganan cepat dan tepat
- gejala berat
- komplikasi intra-kranial
- Bersama sinussitis ethmoidalis homolateral
![Page 25: Sinusitis Paranasalis](https://reader036.vdocuments.site/reader036/viewer/2022081501/55cf9cec550346d033ab8b1f/html5/thumbnails/25.jpg)
SINUSSITIS FRONTALIS AKUT
GAMBARAN KLINIK : “Frontal pain-headache” – berat & periodik Nyeri tekan atap orbita Udema palpebra superior (jarang) Sekret di meatus nasi media
PEMERIKSAAN : Transiluminasi X-foto CT-Scan
![Page 26: Sinusitis Paranasalis](https://reader036.vdocuments.site/reader036/viewer/2022081501/55cf9cec550346d033ab8b1f/html5/thumbnails/26.jpg)
SINUSSITIS FRONTALIS AKUT
• DIFFERENTIAL DIAGNOSIS :
- Herpes n. supra orbitalis
• TERAPI :
- Ringan infraksi – drenasi membaik
- Berat trepanasi pasang tube
irigasi / bilas drenasi baik
- Ideal BSEF
![Page 27: Sinusitis Paranasalis](https://reader036.vdocuments.site/reader036/viewer/2022081501/55cf9cec550346d033ab8b1f/html5/thumbnails/27.jpg)
SINUSITIS FRONTALIS KRONIK
• Jarang sendiri – multi/pan sinussitis
• Bila konservatif gagal operasi
- Konvensional :
- Op. King “external approach”
- Op. Howarth
- Endoskopik – endonasal ---- ideal - BSEF
![Page 28: Sinusitis Paranasalis](https://reader036.vdocuments.site/reader036/viewer/2022081501/55cf9cec550346d033ab8b1f/html5/thumbnails/28.jpg)
SINUSSITIS ETHMOIDALIS
• Sejak lahir terlengkap ---- sering pada anak
(batuk kronik-persisten-komplikasi SE)
• Gambaran Klinik :
- “Ethmoidal pain” – cephalalgia
- Rinore – “post nasal dripping” (menonjol)
- Udema palpebra
- Batuk-apathis-konsentrasi - Sekret di meatus nasi superior + media
![Page 29: Sinusitis Paranasalis](https://reader036.vdocuments.site/reader036/viewer/2022081501/55cf9cec550346d033ab8b1f/html5/thumbnails/29.jpg)
SINUSSITIS ETHMOIDALIS
• TERAPI : - Infraksi - “Replacement suction” Proetz - k/p BSEF
• SE kronik terapi khusus : - Intranasal ethmoidektomi - Operasi Horgan (transanthral) - External ethmoidektomi (Paterson) - Ideal-efisien BSEF
![Page 30: Sinusitis Paranasalis](https://reader036.vdocuments.site/reader036/viewer/2022081501/55cf9cec550346d033ab8b1f/html5/thumbnails/30.jpg)
SINUSITIS SPHENOIDALIS ( SSph )
SSph Akut
• Diagnosis :- Sulit posisi anatomik & ostium di meatus nasi superior hanya bisa X-foto dan
CT-Scan / MRI sering terabaikan frekuensi > tinggi- Ditemukan kebetulan sebagai bagian dari
pansinussitis !
![Page 31: Sinusitis Paranasalis](https://reader036.vdocuments.site/reader036/viewer/2022081501/55cf9cec550346d033ab8b1f/html5/thumbnails/31.jpg)
SSph Akut
• Gambaran Klinik : Rinore “post nasal dripping” (menonjol) Cephalalgia – vertex, occipital, temporal, frontal Sekret antara septum-concha media
• Terapi : “Replacement suction” Proetz
Punksi – bilas Konvensional sulit ! BSEF
![Page 32: Sinusitis Paranasalis](https://reader036.vdocuments.site/reader036/viewer/2022081501/55cf9cec550346d033ab8b1f/html5/thumbnails/32.jpg)
SSph Kronik
• Terapi :
- Operasi khusus – operasi Horgan, operasi
Paterson, punksi-bilas
Semua ini sulit (konvensional)
- Ideal – efisien BSEF
( transnasal, transseptal, trans ethmoidal)
![Page 33: Sinusitis Paranasalis](https://reader036.vdocuments.site/reader036/viewer/2022081501/55cf9cec550346d033ab8b1f/html5/thumbnails/33.jpg)
• Komplikasi sinussitis supurativa Sudah jarang (antibiotik bagus) Terjadi waktu exaserbasi akut Penyebaran : – Langsung : - Osteitis
- Osteomyelitis - Osteoporosis – dehisensi
Lamina papiracea – Vena : - “Septic venous thrombosis”
- “Thrombosis retrograd” - Limfogen - Spacia perineural N. I
![Page 34: Sinusitis Paranasalis](https://reader036.vdocuments.site/reader036/viewer/2022081501/55cf9cec550346d033ab8b1f/html5/thumbnails/34.jpg)
• Jenis Komplikasi :1. Osteomyelitis - jarang (SF)
2. Komplikasi mata
- Jarang
- Pada anak akibat SE -- “orbital
cellulitis” (+/- sub periostal abses)
Gejalanya :
- nyeri mata-pergerakan mata
- chemosis-udema conjunctiva + palpabrae mata tertutup
- diplopia
- udema retina
![Page 35: Sinusitis Paranasalis](https://reader036.vdocuments.site/reader036/viewer/2022081501/55cf9cec550346d033ab8b1f/html5/thumbnails/35.jpg)
• Differential Diagnosis :
Dacryocystitis
Thrombosis sinus cavernosus
Mucocele
Kista mata
Osteoma
Malignitas mata
![Page 36: Sinusitis Paranasalis](https://reader036.vdocuments.site/reader036/viewer/2022081501/55cf9cec550346d033ab8b1f/html5/thumbnails/36.jpg)
• Pengobatan :
Sering cukup antibiotik Sub-periostal abses incisi Akibat SF – incisi + drenasi
TENANG : Operasi radikal Konvensional BSEF terbaik
• Prognosis :Baik – sembuh sempurna tanpa ggn visus
![Page 37: Sinusitis Paranasalis](https://reader036.vdocuments.site/reader036/viewer/2022081501/55cf9cec550346d033ab8b1f/html5/thumbnails/37.jpg)
3. Komplikasi intrakranial (neurologi !)
- Meningitis +/- extra-subdural abses- Thrombosis sinus Cavernosus - longitudinalis- Encephalitis-abses cerebri
Bisa oleh semua sinusitis !- SF --- osteitis -- abses lobus frontalis- SE --- meningitis- SSph --- meningitis – thrombosis- SMax jarang --- hematogen
![Page 38: Sinusitis Paranasalis](https://reader036.vdocuments.site/reader036/viewer/2022081501/55cf9cec550346d033ab8b1f/html5/thumbnails/38.jpg)
4. Dampak sekunder :
- Infeksi sekitar SPN terutama anak !
- Bronchiectasis (?)
- Asthma bronchiale
--- “Chronic infective allergic sinussitis”
- Operasi SP --- meringankan asthma !
- Fokus infeksi : - polyarthritis
- tendo-synovitis