Sinusitis maxillaris
Introduktion - Sinusitis maxillaris er en inflammationstilstand, der udvikles i kæbehulens slimhinder. Tilstanden er ofte forudgået af forkølelse, og afhængigt af sygdomsvarighed inddeles sinusitis maxillaris i en akut og en kronisk lidelse. Patogenese - Akut sinusitis maxillaris forårsages oftest af invasion af patogene bakterier forudgået af viral infektion. Der opstår ødematøse slimhinder og dermed obstruktion af afløbsforholdene, hvorved muligheden for vækst af de patogene bakterier øges. Kronisk sinusitis er karakteriseret ved længerevarende symptomer med strukturelle forandringer i slimhinder med eller uden nasal sekretion og med eller uden polypdannelse. I svære tilfælde ses knogleforandringer. Symptomer - Akut sinusitis er karakteriseret ved tiltagende symptomer over få dage i form af trykkende smerter over kæbehulerne, feber, nasal stenose, purulent nasal sekretion og nedsat lugtesans. Smerter forværres ved foroverbøjning af hovedet. Kronisk sinusitis har et længerevarende og mildere sygdomsforløb. Udredning - og diagnose Sinusitis maxillaris er en klinisk diagnose. Mikrobiologisk diagnosticering udføres sjældent, da det kræver kæbehulepunktur og dyrkning af sekret. Ortopanoptagelse eller CT-scanning kan understøtte diagnosen. Behandling - Akut sinusitis behandles med saltvandsopsnusninger, detumescerende næsespray eller steroid næsespray. Ved mistanke om bakteriel involvering suppleres med antibiotikum. Kronisk sinusitis behandles med steroid næsespray og næseskylninger. Systemisk kortikosteroid kan anvendes ved nasal polypose, og antibiotikum kan anvendes ved forværring af symptomer efter podning og resistensbestemmelse. Ved persisterende symptomer trods medicinsk behandling kan operativt indgreb i form af funktionel endoskopisk sinuskirurgi være nødvendigt for at genskabe afløbsforholdene.
Klinisk relevans:
Maxillary sinusitis
Introduction - Maxillary sinusitis is an inflammatory condition that develops in the mucus membrane of the maxillary sinus. The condition is often preceded by a common cold, and depending upon the duration of the illness, maxillary sinusitis is divided into acute illness and chronic disease. Pathogenesis - Acute maxillary sinusitis is most often caused by the invasion of pathogenic bacteria preceded by viral infection. Oedematous mucus membranes will develop which lead to obstruction of the drainage, and thereby possible growth of pathogenic bacteria. Chronic rhinosinusitis is characterized by longlasting symptoms with structural changes in mucus membranes with or without nasal secretion and with or without polyp formation. In severe cases changes are seen in the bony structures. Symptoms - Acute rhinosinusitis is characterized by increasing symptoms over a few days in the form of pressing pain located in the maxillary sinuses, fever, nasal stenosis, purulent nasal discharge and reduced sense of smell. When stooping the head, pain is aggravated. Chronic rhinosinusitis has a longer-lasting but milder disease progression. Diagnosis and elucidation - Maxillary sinusitis is a clinical diagnosis. Microbiological diagnosis is seldom accomplished, as it requires puncture of the maxillary sinus and culturing of secretion. Orthopantomography or CT-scanning may substantiate the diagnosis. Treatment - Acute rhinosinusitis is treated with nasal saline irrigation, topical decongestants or topical glucocorticoids. If bacterial involvement is suspected antibiotics are given. Chronic rhinosinusitis is treated with topical glucocorticoids and nasal saline irrigation. Systemic glucocorticoids can be used to treat nasal polyposis, and antibiotics can be given if symptoms have worsened after performing inoculation, and determination of resistance. If symptoms become persistent in spite of medical treatment, an operative intervention in the form of functional endoscopic sinus surgery may be appropriate.
