What is Your Diagnosis Sinusitis

Acute sinusitis: Acute sinusitis may go along with a collection of infected secretions in the sinus that can obliterate the sinus completely or partially—an air-fluid level may be visible on the sinus radiographs (Fig. 13.7a). Acute sinusitis is mostly viral in nature, but a dental cause must always be considered. If the dental abnormality is not treated or if the drainage of the paranasal sinuses is hampered—owing to stenosed ostia or chronically swollen mucous membranes—conservative therapy may fail. To evaluate which surgical procedure is best suited, a dedicated CT of the paranasal sinuses is necessary because it depicts the osseous septae and the soft tissues with superb clarity. If the sinusitis is left untreated or therapy is unsuccessful, extension into the facial soft tissues (Fig. 13.7b) is possible. If the infection reaches the orbit (Fig. 13.7c), damage to the optical nerve or the eye bulb may result. If the infection perforates into the cranial vault, the consequences may be fatal (Fig. 13.7d). Septic cavernous sinus thrombosis is another feared complication of any serious and long-standing infection in the nasal/paranasal tissues. Chronic sinusitis: Chronic sinusitis is the end result of recurring or therapy-refractory sinus infections (Fig. 13.8). If the perisinusoidal bone is sclerosed and the sinus itself has lost volume, this diagnosis can be made on the basis of imaging.

b Perforation into the facial soft tissues

Maxillary Sinus Fracture Treatment
c Perforation into the orbit
Maxillary Sinus Perforation Treatment

Fig. 13.7a The fluid level in the left maxillary sinus indicates sinusitis if the clinical symptoms fit. A fracture of the maxilla could, of course, also produce such a fluid level when bleeding into the sinus occurs. b The axial CT image through the orbits (note the eye lenses) demonstrates an infiltration of the left periorbital soft tissues as a consequence of a treatment failure in maxillary sinusitis. Nicely depicted are the medial and lateral ocular muscles as well as the course of the optic nerve on the right. c This coronal CT image through the posterior orbit—note the optic nerve (arrow) and the orbital muscles on the right—documents the extension of acute maxillary sinusitis into the orbit.

Fig. 13.7a The fluid level in the left maxillary sinus indicates sinusitis if the clinical symptoms fit. A fracture of the maxilla could, of course, also produce such a fluid level when bleeding into the sinus occurs. b The axial CT image through the orbits (note the eye lenses) demonstrates an infiltration of the left periorbital soft tissues as a consequence of a treatment failure in maxillary sinusitis. Nicely depicted are the medial and lateral ocular muscles as well as the course of the optic nerve on the right. c This coronal CT image through the posterior orbit—note the optic nerve (arrow) and the orbital muscles on the right—documents the extension of acute maxillary sinusitis into the orbit.

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