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INFLAMMATORY DISEASES OF THE NANOLAIN SINAS
Inflammatory diseases of the paranasal sinuses (sinusitis) are among the most common diseases of the upper respiratory tract. According to the literature, patients with sinusitis make up about 1/3 of the total number of hospitals hospitalized in ENT (Kozlov M.Ya., 1985; Soldatov IB, 1990; Piskunov GZ et al., 1992; Aref'eva N.A. , 1994). The foci of inflammation in the paranasal sinuses can be a source of infectious sensitization of the underlying respiratory tract and lungs, as well as cause severe orbital and intracranial complications.
Most authors on the frequency of involvement in the inflammatory process put in the first place the maxillary sinus (maxillary sinusitis), then the ethmoid labyrinth (ethmoiditis), frontal (frontal sinusitis) and sphenoid (sphenoiditis). However, this provision cannot be considered completely flawless. In the inflammatory process, not one, but several sinuses (polysynitis) are often involved. In this case, in case of damage to the sinuses of one side, they speak of hemisinitis, and in case of damage to all sinuses - about pansinitis.
Often the sinus is susceptible to the inflammatory process. Clinicians know the expression: "inflammation loves the sinuses."
In children, taking into account the age-related development of sinuses, up to 3 years of age, inflammation of the ethmoid labyrinth predominates (up to 80 - 90%), and from 3 to 7 years of age, combined lesions of the ethmoid labyrinth and maxillary sinuses predominate (Soldatov IB, 1990).
In the etiology of both acute and chronic sinusitis, the penetration of the infection into the paranasal sinuses is of primary importance. The most common route is through natural anastomoses that communicate with the sinus to the nasal cavity. In acute infectious diseases (typhoid, diphtheria, scarlet fever, measles), sinus infection is possible through the hematogenous route. In the etiology of maxillary sinusitis, purulent foci of the dento-maxillary system, especially large and small molars adjacent to the lower wall of the sinus, also play a role. The most common cause of odontogenic maxillary sinusitis is foreign bodies that enter the sinus from the oral cavity: filling material, fragments of broken dental instruments, failed tooth roots, and turunds. Granulomas at the root of the tooth, subperiosteal abscesses, periodontal disease can also lead to the occurrence of odontogenic maxillary sinusitis (Ovchinnikov Yu.M., 1995). It is possible that the infection will be brought in when the sinuses are wounded with a gun or other weapon.
The most common cause of acute sinusitis is acute respiratory, including viral diseases. Significant importance, along with influenza and parainfluenza viruses, is given to rhinoviruses and adenoviruses, as well as staphylococci, streptococci, pneumococci, gram-negative and gram-positive bacilli. In some cases, crops from the sinuses in acute sinusitis turn out to be sterile, which is explained by the presence of viral as well as anaerobic flora detected only by special research methods.
Monoflora is characteristic of acute sinuites, and polyflora is chronic.
In chronic sinusitis, along with coccal flora, Pseudomonas aeruginosa, Escherichia coli and various strains of the vulgar protea are found.
Significantly more often than in acute sinuitis, especially in targeted searches, anaerobic flora is found (Lushnikova T.A., 1992, Dainyak LB, 1994). In recent years, fungal infection of the paranasal sinuses has become relevant.
Not being the primary etiological factor in the development of sinusitis, fungal flora due to dysbiosis caused by irrational antibiotic therapy may be the dominant or even the only factor supporting the persistent chronic inflammatory process in the sinuses. It can be the cause of further dangerous development of the disease in the form of deep mycosis (Stammberger H., 1982; Dainiak LB, 1994). The most commonly sown mushrooms of the genus Aspergillus, Penicillum and Candida (Kunelskaya V.Ya., 1989). In the pathogenesis of acute and especially chronic sinusitis, impaired ventilation (aeration) of the paranasal sinuses caused by anatomical defects of the nasal cavity (pronounced curvature of the nasal septum, hypertrophy of the middle nasal concha, the presence of abnormal bulla ethmoidalis), as well as congenital narrowness of the nose (leptorinia) is important.
When the sinus anastomosis is closed by the edematous mucosa, the oxygen content in the sinus will decrease, and the carbon dioxide content will increase. The oxygen content is especially reduced if pus is produced in the sinus (Drettner B., 1984). In the presence of pus, the oxygen content in the sinus approaches zero, the carbon dioxide content increases significantly, and the pH decreases - (Carentfeld C., Lundberg S., 1977). Oxygen is absorbed not only by the mucous membrane, but also by bacteria and leukocytes (Drettner B., 1984). All this contributes to the development of anaerobic infections in chronic sinusitis.
A significant role in the development of acute and chronic sinusitis is played by allergic processes (auto- and bacterial allergies), as well as a known determinism associated with congenital or acquired immunological deficiency. Currently, it has been established that one of the main reasons for the development of recurrent inflammatory diseases of the upper respiratory tract, including paranasal sinuses, there is a deficiency of immunoglobulins, in particular, secretory Ig A. The clinical expression of Ig A deficiency in the mucous membrane of the upper respiratory tract is manifested in the form of chronic rhinitis, polysynitis, chronic tonsillitis, adenoiditis, etc. (Gerber V.X., 1989; Komarets S.A., 1992; Grebenshchikova L.A., 1994; Lantsov A.A. et al., 1996).
Of great importance in the development of acute and chronic sinusitis is a violation of the normal function of the ciliated epithelium and mucous glands (mucociliary apparatus of the mucous membrane) caused by adverse environmental factors: cold air, air pollution by harmful industrial gases. As a result, there is inhibition or cessation of ciliary beat, which leads to a delay in the infectious onset in the nasal cavity and paranasal sinuses and its subsequent penetration through the membranes of the mucous membrane (Ostakovich V.E., 1982, Pankova VB, 1987, Piskunov G. 3 . and Piskunov S.3., 1988, Pluzhnikov M.S. and Lavrenova G.V., 1990). A significant decrease in the functional activity of the ciliated epithelium of the mucous membrane in the middle and lower nasal concha was established in acute and chronic ethmoiditis and maxillary sinusitis (Bondaruk V.V., 1996).
The development of acute and especially chronic sinusitis is promoted by chronic diseases, including diabetes.
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INFLAMMATORY DISEASES OF THE NANOLAIN SINAS
- Diseases of the paranasal sinuses
Inflammatory diseases of the paranasal sinuses account for 25-30% of the stationary pathology of the LOP organs. Most often, inflammation occurs in the maxillary (maxillary) sinus (sinusitis). This is due to the fact that evacuation of the contents from the sinus is difficult due to the location of the anastomosis with the nasal cavity in the upper third of its medial wall, as well as the fact that the inflammation of the roots of the four posterior
- Surgery for diseases of the nose and paranasal sinuses
The most common operations for diseases of the nose and paranasal sinuses include polypectomy, endoscopic interventions in the paranasal sinuses, opening the maxillary sinus (Caldwell-Luc operation), rhinoplasty, septoplasty. Preoperative period Patients often have marked nasal breathing disorders due to polyps, nasal curvature
- DISEASES OF THE NOSE AND NEXTILOUS SINAS, THROATS, Larynx and Ear
The upper respiratory tract (nose, paranasal sinuses, pharynx and larynx) perform the most important life-supporting functions, a detailed description of which is given in Part I. The next part is devoted to diseases of these organs. Based on the functional significance in the clinic of each of the organs - reflex, humoral and other connections of these organs with the body as a whole, we can conclude
- DISEASES OF THE NOSE AND SINUS NANOSIS
DISEASES OF THE NOSE AND NEXTLINE
- Allergic diseases of the paranasal sinuses (allergic sinusitis)
Acute and chronic allergic diseases of the paranasal sinuses represent a special category of pathological conditions of the mucous membrane of the upper respiratory tract resulting from an increased sensitivity of the patient's body to a foreign protein (antigen or allergen) and due to neurogenic and endocrine disorders. In the pathology of the disease a large role belongs
- TUMORS OF THE NOSE AND NANOPINASUS SINAS
In the nasal cavity and paranasal sinuses, as in other ENT organs, there are benign and malignant neoplasms, very diverse in morphological structure and clinical manifestation. A distinct border is often impossible to draw with many benign and malignant tumors. Modern classifications of tumors, including the nose and paranasal sinuses, are bulky and
- Anatomy of the paranasal sinuses
The paranasal sinuses, sinus paranasalis, are located in the bones of the facial and brain skulls and communicate with the nasal cavity. They are formed as a result of the ingrowth of the mucous membrane of the middle nasal passage into the spongy bone tissue. In fig. 2.1.4 presents a diagram of the development of the paranasal sinuses in the age aspect. Phylogenetically paranasal sinuses are derivatives of the ethmoid labyrinth
- Injuries to the paranasal sinuses
In adults and children, the frontal sinuses are most often damaged, then the maxillary sinuses, the ethmoid labyrinth and very rarely the sphenoid sinus. Usually, a trauma to a sinus is combined with damage to other parts of the facial skeleton, cranial cavity, and eyes. A mechanical or gunshot wound to the frontal sinus is often accompanied by damage to the anterior lobe of the brain, ethmoid labyrinth, sieve
- The structure of the paranasal sinuses
The paranasal sinuses are located around the nasal cavity and communicate with it (Fig. 3). Only four pairs of airways: sinuses, maxillary labyrinth cells, frontal and sphenoid. There are anterior (maxillary, frontal, anterior and middle cells of the ethmoid bone) and posterior (sphenoid and posterior cells of the ethmoid bone) sinuses. Such a unit is convenient because pathology
- Clinical anatomy of the paranasal sinuses
The paranasal sinuses are located around the nasal cavity and communicate with it (Fig. 1.8). Only four pairs of airways: sinuses, maxillary labyrinth cells, frontal and sphenoid. There are anterior (maxillary, frontal, anterior and middle cells of the ethmoid bone) and posterior (sphenoid and posterior cells of the ethmoid bone) sinuses. Such a unit is convenient because pathology
- NEXT SINUS (SINUSES) HORSES
The paranasal sinuses are additional extensions of the nasal cavity. They do not make any direct contribution to the sense of smell or breathing - two functions assigned to the nasal cavity. The general shape of the skull is determined to a large extent by elongated and deepened jaws and muscles associated with them. This means that a “support” is required to support the elongated jaws, and the bone between the supports and
- Anatomical and topographic features of the paranasal sinuses
There are four pairs of airy paranasal sinuses: maxillary, ethmoid labyrinth cells, frontal and sphenoid. There are anterior (maxillary, frontal, anterior and middle cells of the ethmoid bone) and posterior (sphenoid and posterior cells of the ethmoid bone) sinuses. Communication with the nasal cavity of the front sinuses occurs through the middle nasal passage, and the rear through the upper. Back diseases
- Malignant tumors of the nose and paranasal sinuses
Malignant diseases of this localization - cancer and isarcoma, as a rule, are primary. They are relatively rare, more often in middle-aged and elderly men. The most common primary malignant process affects the maxillary, then ethmoid, frontal and sphenoid sinuses. Rarely, the nasal septum is the source of the malignant tumor. Malignancy
- Clinical physiology of the nose and paranasal sinuses
Distinguish between upper and lower respiratory tract. The nose and paranasal sinuses, pharynx with the oral cavity and larynx belong to the upper respiratory tract, the trachea, bronchi with bronchioles of the alveoli - to the lower. Normal for a person is breathing through the nose. The nose performs, in addition to the respiratory, protective, resonant and olfactory functions, and also participates in the regulation of the depth of breathing and lacrimation,
- METHODS FOR STUDYING THE NOSE AND NANOSAXIS
The study of the nose and paranasal sinuses, after identifying the needles and clarifying the history, begins with an external examination and palpation. On examination, pay attention to the condition of the skin and soft tissues, the absence or presence of defects, the symmetry of both halves of the face, as well as the shape of the external nose. Palpation should be done carefully. With soft hand movements, the presence or
- CLINICAL PHYSIOLOGY OF THE NOSE AND NANOSAXIS
The nose and its paranasal sinuses, being the upper part of the respiratory tract, play an important role in the interaction of the body with the environment, while performing a number of interrelated physiological functions. The following nasal functions are distinguished: 1) respiratory, 2) protective, 3) resonator (speech) and 4) olfactory. In addition, the nose, as an important element in the formation of a single ensemble of the face, is endowed with and
- Research methods for the nose and paranasal sinuses
They produce an external nose nose, places of projection of the paranasal sinuses of the nose on the face. Patch of the external nose: the index fingers of both hands are located along the back of the nose, with light massaging movements they feel the areas of the root, slopes, back and tip of the nose. Palpate the front and lower walls of the frontal sinuses, figuring out the patient's sensations. Thumbs of both hands
- Microendoscopic methods of surgical intervention in the nasal cavity and paranasal sinuses
There are a number of options for endonasal endoscopic microoperations, however, all the techniques can be combined into two main varieties - these are the classic methods according to Messerklinger and Wiegand, they are designed to restore the natural ventilation and drainage paths, with the smallest changes in the anatomical structures and the maximum gentleness of the mucous membrane. Most widely
- Headaches due to inflammation of the paranasal sinuses
Clinic. Headaches are noted in both acute and chronic processes in the paranasal sinuses. The frequency of headaches and the variation in their intensity from 12 to 17 hours are typical. The intensification of headaches in the middle of the day is due to the difficulty in the outflow of pus from the sinuses due to a change in body position from horizontal to vertical. This increases the irritation of sensitive
- Foreign bodies of the nose and paranasal sinuses
Most often, foreign bodies are found in children who have the habit of putting various objects (beads, buttons, stones, coins, berry seeds, seeds and other small objects) in the nose of themselves or their gullible peers. In adults, foreign bodies get into the nose under random circumstances (for example, during sleep in the hayloft, a piece of straw may be drawn into the nose when breathing). More