Paranasal sinuses. Maxillary sinus: anatomy of the maxillary sinuses located in the body

The paranasal sinuses are air-filled voids that are located in the bones of the facial skull. They have some ducts into the nasal cavity. In total, humans have 4 groups of cavities; the maxillary and frontal cavities are located symmetrically, that is, on both sides of the nose. Their inner surface is lined with epithelium with certain cells that have the ability to produce mucous contents. Mucus of this kind moves towards the ducts with the help of cilia and is expelled.

The paranasal sinuses surround the human nose on all sides; they are presented in the form of cavities, which include the maxillary sinuses. Based on their location, they are called the maxillary sinuses, and they received their first name in honor of the English physician who first described the disease sinusitis. In the internal parts of such cavities there are blood vessels and nerve endings. Such components are displaced into the nasal cavity using the anastomosis.

Features of the structure of the maxillary sinus

The maxillary sinuses are formed much earlier than the air cavities located in the facial part of the skull. In infants they look like some small dimples. The process of their formation is completely completed by the age of 12-14 years.

It is interesting to know that in older people, bone tissue often breaks down, and that is why their maxillary sinus enlarges.

The anatomical structure of the maxillary sinuses is as follows. They are combined with the nasal cavity through a narrow-shaped connecting channel, which is called an anastomosis. The anatomical feature of their structure is that in a calm state they are filled with oxygen and pneumotized. Inside, these recesses consist of thin mucous membranes, on which a number of nerve plexuses and elastic formations are located. That is why, localized in the nasal cavities, it often occurs in a latent form, and only then do pronounced symptoms appear.

The maxillary sinuses consist of upper, outer, inner, anterior and posterior walls. Each of them has individual characteristics. It is worth noting that you can notice the manifestation of the disease on your own, but you should not take any action aimed at treatment. Self-medication is a rather dangerous activity, which often causes negative consequences. A person should contact a specialist who will select treatment.

Anastomosis and its structure

This part of the nose is responsible for the free circulation of air inside the cavity. The anastomosis of the maxillary sinuses is located in their posterior walls. It has a round or oval shape. The size of the anastomosis is from 3-5 millimeters. It is covered with mucous membranes, which contain a minimum of nerve endings and blood vessels.

The anastomosis has the ability to expand and contract. It increases due to the outflow of mucus, which protects it. The following reasons can provoke a narrowing of the anastomosis:

• viral and infectious diseases;
• structural features of the body;
• various pathologies of the upper respiratory tract.

In the anastomosis there are many small particles called cilia, which are constantly in motion and push accumulated mucus to the exit. If the anastomosis has a significant diameter, the mucous contents, as a rule, do not have time to accumulate. In this case, evacuation of the contents is ensured even during viral diseases.

Changing the configuration of the anastomosis certainly affects the development of diseases. If the anastomosis decreases, the mucus produced accumulates in the cavity, and then it stagnates. This creates the most favorable environment for the development and reproduction of pathological bacteria. It happens, and sinusitis is diagnosed.

Vasodilation also often causes pathology, in some cases cysts occur. This happens because with each inhalation a current of cool air enters the cavity. In most cases, formations of this kind do not require therapy, but constant monitoring of them is simply necessary. The patient’s main task is simply to regularly visit the otolaryngologist.

Top and bottom walls

The thickness of the upper walls of the maxillary sinuses does not exceed 1.2 mm. They border the orbit, and that is why the inflammatory process in such a cavity often has a negative effect on the eyes and visual function in general. It is worth noting that the consequences in this case can be the most unpredictable. Against the background of sinusitis, conjunctivitis and other, more dangerous pathologies of the organs of vision often develop.

The thickness of the lower wall is quite small; in certain areas of the bone it is completely absent, and the vessels and nerve endings passing through such places are separated only by the periosteum. It is this factor that increases the risk of sinusitis due to dental diseases. This occurs due to the fact that the roots of the teeth of the upper jaw are located quite close and are not protected.

Inner wall

The inner wall is also called the medial wall and is located next to the middle and lower nasal passages. The adjacent zone is often connected, but at the same time quite thin. It is through this that they are often carried out.

The wall joining the lower passage, in most cases, has a membranous structure. In this area there is an opening of the maxillary sinus, through which the maxillary sinuses and nasal cavities connect, and if blocked, an inflammatory process is formed. That is why it is worth remembering that a common runny nose should be a reason to see a doctor, because prolonged self-medication often causes negative consequences.

It should be noted that the maxillary sinus has an anastomosis, the length of which reaches 1 centimeter. Due to its location in the upper part, sinusitis takes on a chronic form. This is due to the fact that the outflow of fluid is very difficult.

Front and back walls

The facial wall of the maxillary sinuses is characterized as the densest. It is covered by the tissues of the cheek, and only it is accessible for palpation. On its front wall there is a canine fossa, which is used as a guide when opening the mandibular cavity.

A recess of this kind can have different depths. In some cases, it reaches a significant size and when puncturing the sinuses from the lower nasal passage, the needle has the ability to penetrate the orbit or soft tissue of the cheek. This often becomes the cause of purulent complications, therefore it is extremely important to involve only an experienced specialist to perform the manipulation.

The posterior wall of the maxillary sinuses is often adjacent to the maxillary tubercle. The reverse side is turned towards the pterygopalatine fossa, in which a certain specific venous plexus is located. Do not forget that with inflammatory processes in the paranasal sinuses, blood poisoning is possible.

The maxillary sinus performs the most important internal and external functions. Among the internal ones, ventilation and drainage are distinguished, among external ones - barrier, secretory and suction.

Anatomical features

The maxillary sinuses do not have a constant size and shape throughout a person’s life, but change significantly along with the growing bones of the skull, that is, they are directly tied to age-related characteristics. In most cases, the shape of these important formations is reminiscent of an irregular pyramid with four sides. The parts of this pyramid are called:

• Ophthalmic (is the upper one);
• Facial (is the front);
• Rear;
• Internal.

Maxillary sinuses

The pyramid is based on the bottom part or, as it is also called, the bottom wall. It often turns out that the bottom of the pyramid has outlines that are far from symmetrical.

The walls of these anatomical formations are responsible for their volume. Naturally, the smaller the thickness of a particular part, the larger the cavity will be, and vice versa - the greater the thickness, the smaller the volume.

If the anatomical development of the facial skeleton is not disrupted, then the maxillary sinuses are directly connected to the nasal cavity.

In the inner part of the formations there is a special hole that opens into the median passage of the nose.

The bottom structure of the maxillary sinuses is formed with the participation of the process of the maxillary bone, which is called the alveolar. Thanks to this same small layer of bone tissue, the sinuses and oral cavity are separated.

The wall of the cavities, located below, is in close proximity to the upper teeth, which explains the frequent spread of the inflammatory process from the roots of the teeth in the cavity, and then further to the eye sockets and meninges.

Interesting! Another significant feature of the bottom of this anatomical formation is that its mucous membrane has a small number of receptors, which is why inflammation in the early stages occurs without pronounced symptoms and is detected in an already advanced form.

Ocular wall

The walls of this structure are characterized by a small thickness. The posterior part of this structure is the thinnest compared to other parts.

The main feature of the posterior wall of the eye is that in the immediate vicinity of it there is not only a canal in which the infraorbital nerve runs, but also several large vessels.

Important! Inflammation affecting the eye wall is dangerous, first of all, due to the threat of damage to the infraorbital nerve and the spread of inflammation into the eye orbit.

Inner wall

This structure is located close to two important nasal passages - the middle and inferior. Another important anatomical characteristic is provided by the thickness of the structure - it is uneven in different sections, increasing from top to bottom.

Closer to the bottom of the orbit, that is, in the upper part of the wall, there is a small round hole that provides a connection between the nasal cavity and the sinus cavities.

The posterior part of the internal structure is dotted with ethmoidal cells, and at the junction of the internal nasal wall with the anterior one there is a nasolacrimal duct.

Inner wall of the maxillary sinuses

Front wall

Closer to the alveolar process of the maxillary bone, the facial wall of the sinuses is formed. The infraorbital margin also takes part in the formation of this structure. This part has the greatest thickness, which makes it stand out among others.

On the side of the face, the sinuses are covered with soft tissues of the cheeks, so they can be felt if desired.

A special feature of the facial part is that one of the branches of the trigeminal nerve runs along its surface.

Back wall

The maxillary tubercle defines the location of the posterior side. The dorsal surface of this part is in close contact with the pterygopalatine fossa, which is why with sinusitis there is always a risk of developing blood poisoning, since one of the venous plexuses of the body is located there.

How do the maxillary sinuses relate to the teeth?

Maxillary sinuses and teeth

There are three options for the possible relationship of the maxillary sinuses to the teeth located in the upper jaw:

1. The bottom surface of the nasal cavity is lower than the lower part of the anatomical formation;
2. The bottom surface of the nasal cavity and the bottom of the sinuses are at the same level;
3. The bottom surface of the nasal cavity rises above the bottom of the anatomical formation, which is why the roots of the teeth of the upper jaw come close to the lower wall of the sinuses.

What functions do the sinuses perform?

The maxillary sinuses are an important anatomical formation. They perform the following functions:

1. Warming, humidifying and purifying the air that enters the nasal cavities from the environment, therefore ensuring respiratory function.
2. Resonance activity during conversation. The maxillary sinuses provide the individual characteristics of vocal sound. It is these sinuses and other cavities of the facial part of the skull that are responsible for the variety of timbre and sound of voices inherent in different people.
3. Olfactory function. Thanks to these cavities, a person’s ability to sense and distinguish different odors is formed.
4. Filter function, for which the epithelium lining the maxillary sinuses is responsible.

The location of the maxillary sinuses is very close to other important anatomical structures, such as the orbit, cranial nerves, and large vessels. That is why it is important to promptly treat diseases of these sinuses in order to prevent the process of inflammation from spreading and prevent the development of life-threatening consequences.

Adjacent to the nasal cavity on each side top maxillary and frontal sinuses, ethmoid labyrinth and partly sphenoid sinus.

Maxillary, or Gaimorova , sinus, sinus maxillaris, located in the thickness of the maxillary bone.

It is the largest of all the paranasal sinuses; its capacity in an adult is on average 10-12 cm3. The shape of the maxillary sinus resembles a tetrahedral pyramid, the base of which is located on the side wall of the nasal cavity, and the apex is at the zygomatic process of the upper jaw. The facial wall faces anteriorly, the superior, or orbital, wall separates the maxillary sinus from the orbit, the posterior wall faces the infratemporal and pterygopalatine fossae. The lower wall of the maxillary sinus is formed by the alveolar process of the maxilla, separating the sinus from the oral cavity.

Inner, or nasal, wall of the maxillary sinus from a clinical point of view the most important; it corresponds to most of the lower and middle nasal passages. This wall, with the exception of its lower part, is quite thin, and gradually becomes thinner from bottom to top. The hole through which the maxillary sinus communicates with the nasal cavity, hiatus maxillaris, is located high under the very bottom of the orbit, which contributes to the stagnation of inflammatory secretion in the sinus. The nasolacrimal canal is adjacent to the anterior part of the inner wall of the sinus maxillaris, and the ethmoidal cells are located to the posterosuperior part.

The superior, or orbital, wall of the maxillary sinus thinnest, especially in the posterior region. With inflammation of the maxillary sinus (sinusitis), the process can spread to the orbital area. The canal of the infraorbital nerve passes through the thickness of the orbital wall; sometimes the nerve and blood vessels are directly adjacent to the mucous membrane of the sinus.

Anterior, or facial, wall of the maxillary sinus formed by the area of ​​the upper jaw between the infraorbital margin and the alveolar process. This is the thickest of all the walls of the maxillary sinus; it is covered with soft tissues of the cheek and is accessible to palpation. A flat depression in the center of the anterior surface of the facial wall, called the “canine fossa,” corresponds to the thinnest part of this wall. At the upper edge of the “canine fossa” there is an opening for the exit of the infraorbital nerve, foramen infraorbitale. rr pass through the wall. alveolares superiores anteriores et medius (branches of the n. infraorbitalis from the II branch of the trigeminal nerve), forming the plexus dentalis superior, as well as aa. alveolares superiores anteriores from the infraorbital artery (from a. maxillaris).

The lower wall, or bottom of the maxillary sinus, is located near the posterior part of the alveolar process of the upper jaw and usually corresponds to the sockets of the four posterior upper teeth. This makes it possible, if necessary, to open the maxillary sinus through the corresponding dental socket. With an average size of the maxillary sinus, its bottom is approximately at the level of the bottom of the nasal cavity, but is often located lower.

Sinusitis is an inflammation of the mucous membrane of the maxillary sinus. The disease belongs to the group of sinusitis - one of the most common human diseases. Sinusitis is a collective concept that includes inflammation of the paranasal sinuses: maxillary (sinusitis), ethmoid bone (ethmoiditis), frontal (frontitis), sphenoid (sphenoiditis). A combination of inflammation of all sinuses (pansinusitis) or several (polysinusitis) is possible. Since inflammation of the sinuses is always accompanied by varying degrees of severity of rhinitis (inflammation of the mucous membrane of the nasal cavity), in medical practice it is customary to use the term “rhinosinusitis”.

People of all ages are susceptible to the disease. From 5 to 15% of adults and 5% of children suffer from sinusitis. Rhinosinusitis is a common complication of ARVI (5 - 10%). The incidence of acute sinusitis has increased 2-3 times in the last decade, and the number of hospitalizations in ENT hospitals has increased (from 15 to 35%). More than 10 million cases of sinusitis are registered annually in Russia.

The most common of all sinusitis is sinusitis. The disease not only affects the quality of life of patients, but is also accompanied by quite significant financial costs. The disease debilitates the patient and significantly reduces his quality of life.

The cause of acute sinusitis is a viral infection. Its feature is the rapid restoration of sinus function without treatment. The cause of chronic disease is bacteria and fungi. With increased sensitivity to certain environmental substances (allergies), an allergic form of the disease develops.

Despite the fact that the signs and symptoms of sinusitis are quite clear, patients with this disease are often misdiagnosed, which means inadequate treatment is prescribed.

Rice. 1. Sine location diagram. There is an accumulation of fluid in the maxillary sinuses.

How do the maxillary sinuses work?

The paranasal sinuses are a system of cavities located in the cranium. They can be very small, such as the cells of the ethmoid bone and sphenoid, located on the back of the nose between the eyes and in the bones, behind the nasal cavity. Depending on which sinuses are affected, the following types of sinusitis are distinguished: sinusitis, frontal sinusitis, ethmoiditis and sphenoiditis. The largest in volume are the frontal and maxillary sinuses. The maxillary sinuses are located on both sides of the nose in the depths of the zygomatic bones of the upper jaw. Their volume is about 20 ml. They anatomically border the orbit, the pterygopalatine fossa and the ethmoid bone, where accumulations of nervous tissue are located in the form of a branch of the trigeminal nerve and the pterygopalatine ganglion. When inflammation spreads to these structures, patients develop neurological symptoms.

Rice. 2. The photo shows the location of the paranasal sinuses.

The internal cavities of the sinuses are covered with mucous membrane. Thanks to it, the air in the cavities is moistened. Tiny hairs of the mucous membrane (cilia) help move mucus to the exit, clearing the cavities of contamination - dust and allergens. The bony wall of the sinuses does not have periosteum.

Why a person needs sinuses is not clear. It is believed that they are intended either to humidify the inhaled air, or to enhance the sound of the voice (the cavities affect the depth and tone), or the presence of cavities makes the cranium lighter.

Rice. 3. View of the villi of the mucous membrane of the sinuses.

Causes of sinusitis

The main cause of all sinusitis is microbes - viruses, bacteria, fungi and protozoa.

The main causes of acute sinusitis

Acute sinusitis is caused by viruses and bacteria. Of the bacteria, the most common are Haemophilus influenzae (21 - 35%) and Streptococcus pneumoniae (21 - 43%), somewhat less common - Streptococcus pyogenes (about 4 - 10%), Moraxella catarrhalis (3 - 10%), Staphylococcus aureus (1 - 8%) and aerobes (1 - 9%). Other pathogens account for about 4%. The longer the symptoms, the greater the likelihood that the disease is bacterial in nature.

With ARVI, in 90% of cases, sinusitis of a viral nature develops, which does not require antibacterial treatment. In 1 - 2% of patients with ARVI, the disease has a complicated course.

• A feature of viral sinusitis is the rapid restoration of sinus function without treatment.
• With a disease of a bacterial nature, pain and inflammation manifest themselves to a greater extent than with a viral one. The long-term existence of symptoms of sinusitis indicates its bacterial nature.

The main causes of chronic sinusitis

Chronic sinusitis most often has a bacterial nature, less often - fungal and allergic. The role of chlamydia infection is discussed.

• In 48% of cases, the cause of the chronic form of sinusitis is anaerobes, in 52% of cases - aerobes (Streptococcus, influenzae, P. aeruginosa, S. aureus, M. catarrhalis).
• Cases of chronic sinusitis, in which various fungi are detected, have become more frequent. It is believed that this is due to the uncontrolled use of antibiotics. Fungal sinusitis often develops in people with decreased immunity. The disease always takes a long time and is difficult to treat.
• The role of protozoa in the development of the disease - chlamydia infection is discussed.
• Chronic sinusitis that lasts a long time is often of an allergic nature. Allergic rhinitis is often reported in such patients. The disease develops when the body is hypersensitive to certain environmental substances – allergens. They can be pollen from certain plants, dust mites, animal dander, food, etc. Triggers—tobacco smoke and the odors of certain chemicals—can have a powerful irritating effect.

Factors contributing to the development of the disease

• The level of immune defense plays a significant role in the development of sinusitis. It has been proven that the disease often develops in individuals with reduced cellular and humoral immunity. The disease often occurs during periods of decreased immunity - autumn, winter and winter-spring, when a large number of acute respiratory infections, including those of a viral nature, are recorded. Reduced insolation and vitamin deficiency contribute to the development of the disease during these periods.
• Allergy and environmental conditions play a major role in the occurrence of sinusitis.
• Deviated nasal septum, caused by injury or genetics. Up to 80% of people suffer from this pathology. The nasal septum deviates to one side, narrowing one of the passages.
• Hypertrophy of shells.
• Nasal polyps, which when inflamed, swell and look like bunches of grapes. They partially or completely block the nasal passages;

Rice. 4. A deviated nasal septum is one of the factors causing the disease.

Rice. 5. Odontogenic sinusitis. A foreign object is visible in the maxillary sinus, which could be a tooth root or filling material.

How the disease develops

One of the most popular theories of the development of sinusitis is rhinogenic. With the normal functioning of ciliated cells covered with mucus produced by goblet cells, bacteria cannot have long-term contact with the epithelial cells. But with a viral infection, the large surface of the ciliated epithelium affected by pathogens does not function. Contact with bacterial epithelial cells becomes longer, leading to secondary bacterial infection. The infectious process can affect either one or both maxillary sinuses.

Inflammation of any nature, including allergies, causes the mucous membrane of the sinuses to swell. Excessive mucus production and increased viscosity block the flow into the nasal passages. The contents are trapped. High blood pressure leads to the appearance of a number of specific symptoms in the patient. Due to the lack of periosteum, inflammation of the mucous membrane of the sinuses spreads to the bone structure and destroys it. This is how the infection spreads to surrounding tissues and organs.

The inflammatory effect when exposed to allergens is characterized by dilation of blood vessels and subsequent swelling of the mucous membrane, which leads to the development of symptoms of runny nose and itching. Violation of the outflow of the contents of the maxillary sinuses causes symptoms such as pain and a feeling of fullness in the face.

Rice. 6. On the left is a healthy maxillary sinus, on the right is an inflammatory process.

Increased secretion production and decreased activity of epithelial cells as a result of exposure to viruses or allergens lead to the creation of ideal conditions for the development of bacterial infection.

Clinical forms of the disease

Sinusitis can occur in an acute form, have a subacute and chronic course. The disease can appear several times a year and proceed as an acute inflammation. In this case, we talk about periodic (recurrent) sinusitis.

• Acute inflammation of the maxillary sinuses lasts less than 3 to 4 weeks.
• Subacute course of the disease is observed when inflammation lasts more than 4–8 weeks.
• Sinusitis, which lasts more than 8 - 12 weeks, is regarded as chronic.
• In the recurrent form, there are 2–4 episodes of the disease per year.

Rice. 7. In the photo on the left, the maxillary sinuses are normal (CT). The photo on the right shows acute sinusitis. The picture shows an accumulation of fluid in the cavity on the right.

Signs and symptoms of acute sinusitis

Acute sinusitis develops as a complication of acute respiratory infections and requires intensive treatment. The following factors indicate the disease:

• After 7 days of treatment for acute respiratory infections, cold symptoms do not weaken, but become more pronounced.
• There is no improvement in well-being within 3-5 days from the start of taking antibiotics.

How does acute sinusitis develop?

Viral infection “paves the way” for bacteria. In 90% of cases with ARVI, there is swelling of the sinus mucosa, impaired microcirculation and the development of stagnation of secretions. Normally, the mucous membrane of the maxillary sinuses is very thin (like a sheet of tissue paper), but with disease it thickens 20 to 100 times. Swelling of the mucous membrane leads to blockage of the anastomosis, and the outflow of secretions is disrupted. Stagnation of secretions creates favorable conditions for the development of bacteria. Pressure increases in the blocked maxillary sinus, which is accompanied by symptoms such as pain in the face.

Impaired drainage also occurs as a result of hypertrophy of the nasal mucosa in the case of allergic rhinitis, polyposis, deviated nasal septum, dental diseases, as a result of trauma and intoxication of various origins.

With the development of acute inflammation in the first, early stages of the disease, the exudate is serous, then mucous-serous, and with the development of a bacterial infection, it is purulent, containing detritus and a huge number of leukocytes.

Criteria for diagnosing acute sinusitis

• The viral nature is indicated by the fact that the symptoms of the disease last less than 10 days.
• The bacterial nature is indicated by the worsening of the symptoms of the disease from the 5th day of the disease, and the duration of the sinusitis itself is more than 10 days.

Signs and symptoms of acute sinusitis in mild forms of the disease

Nasal congestion, mucous or mucopurulent discharge from it or into the oropharynx, elevated body temperature (not more than 37.5 0 C) are the main signs of acute sinusitis. Headache, weakness and decreased sense of smell are the main symptoms of the disease. The x-ray shows thickening of the sinus mucosa of less than 6 mm.

Rice. 8. The photo shows acute sinusitis, the initial stage. There is a uniform decrease in the transparency of the sinus in the form of a “veil”.

Signs and symptoms of acute sinusitis with moderate disease

Discharge from the nose or into the oropharynx is purulent in nature, body temperature rises to more than 37.5 0 C, and pain appears when palpating the area in the projection of the maxillary sinus. Symptoms such as headache and weakness, decreased sense of smell, pain and irradiation to the teeth and/or ears appear. The mucous membrane thickens by more than 6 mm. The x-ray shows either complete darkening of the maxillary sinuses or the level of fluid in one of the cavities.

Signs and symptoms of acute sinusitis in severe disease

In severe cases of acute sinusitis, nasal congestion, profuse, purulent discharge from the nose and oropharynx are noted. Sometimes there is no discharge. Body temperature is more than 38 0 C, patients develop symptoms such as severe headache, weakness and complete absence of smell; upon palpation, severe pain is noted in the projection of the sinus. The radiograph shows complete darkening of one or both sinuses. There is an increase in the level of leukocytes in the blood and an accelerated ESR. Intracranial and orbital complications develop or suspicions arise.

Rice. 9. 2-sided acute sinusitis, severe. Accumulation of fluid in cavities.

If the patient has symptoms such as bursting pain in the face, which intensifies when tilting the head or any other movements, the upper teeth hurt, and the nose is stuffy, or there are symptoms of a runny nose with yellowish-greenish discharge, then he may have sinusitis.

Chronic sinusitis is a complex disease in which one sinus is isolated. The disease significantly reduces the quality of life of patients and requires large financial costs for treatment.

Chronic sinusitis is a continuation of the acute course, which did not resolve within 8 to 12 weeks. The disease is bacterial, less often fungal in nature, the role of protozoa (chlamydia) is discussed. Inadequate antibiotic therapy plays a major role in the development of chronic sinusitis, as a result of which the microbial population persists for a long time in the sinus cavity, which leads to changes in the mucous membrane of a productive type - metaplasia of the ciliated epithelium develops into stratified squamous epithelium (dysplasia of 1 - 2 degrees of severity).

The disease always occurs against the background of a decrease in the overall reactivity of the body, often associated with hypovitaminosis. If unsuccessful, the question of surgical treatment arises.

Predisposing factors play a major role in the development of the chronic form of the disease.

• Blockage of the excretory ducts as a result of abnormalities in the structure of the sinuses and nasal turbinates, including a curvature of the nasal septum, which is detected during a CT scan (computed tomography).
• A special role in the development of the disease is played by the complexity of the anatomy and the narrowness of the middle nasal meatus.

Rice. 10. Chronic form of the disease, acute stage. There is an accumulation of fluid in the right sinus.

Signs and symptoms of chronic sinusitis

The main symptoms of chronic sinusitis are nasal congestion and discharge, as well as additional symptoms such as headache, pain in the sinus area and decreased sense of smell.

When the disease occurs, patients complain of difficulty in nasal breathing, especially in winter. The discharge is unilateral, predominantly mucopurulent in nature. Cough, especially at night, is a common symptom of chronic sinusitis. There is thickening of the mucous membrane and its focal hyperplasia with the formation of polypous growths.

Exacerbations of chronic sinusitis are often associated with acute respiratory infections. Patients experience increased headaches, increased body temperature, weakness and malaise, and difficulty breathing through the nose. A few days after the onset of exacerbation, mucous discharge from the nose is replaced by purulent discharge, which causes bad breath. The entry of purulent discharge into the throat causes coughing, especially at night. Nasal discharge may sometimes be absent.

The headache is localized in the frontal region or behind the eye. A symptom such as heaviness when lifting the eyelid appears. When the branches of the trigeminal nerve are involved in the pathological process, the pain becomes acute, radiates to the area of ​​the eye and palate and cannot be relieved by taking analgesics. The intensity of pain after the release of the maxillary sinus during puncture weakens, but after emptying, the pus accumulates again within several hours. Endoscopic examination and CT are the main diagnostic methods.

Complications of chronic sinusitis

The maxillary sinus is separated from surrounding tissues and organs by a bone wall that does not have a periosteum.

• A purulent process can cause a subperiosteal abscess, the clinical picture of which depends on its location. Abscesses localized subperiosteally near the orbital margin are characterized by symptoms such as redness, swelling and swelling of the lower eyelid, sometimes the cheeks, and swelling of the conjunctiva of the eyeball.
• When the infection spreads to the orbital area of ​​the eye, damage to the eye structures develops, which can result in blindness. Initial signs of complications include redness, swelling and swelling of the lower eyelid and cheek.
• Less severe complications include loss of smell and taste.
• In children, osteomyelitis, the occurrence of which is associated with carious teeth, is often the cause of damage to the bone septum.

Complications of chronic sinusitis occur much more often in children than adults, in men (twice) than in women.

Rice. 11. A purulent process in the sinus can cause a subperiosteal abscess.

Sinusitis of fungal nature

Increasingly, in the last decade, sinusitis of a fungal nature has been recorded, which is associated with the widespread uncontrolled use of antibiotics in our country, as well as a general decrease in immunity in young people.

The maxillary sinuses are affected by various types of fungi. The disease is called mycetoma. Signs and symptoms of chronic sinusitis depend on the type of fungus.

In people with impaired immune system function, the disease is acute. People with ketoacidosis, which occurs against the background of diabetes mellitus, are more likely to suffer; it occurs in patients with leukemia and those who have undergone organ transplantation. The maxillary sinuses in this category of people are more often affected by mold fungi. Main symptoms: headache, facial pain and fever. Often the disease is complicated by phlegmon of the orbit. During endoscopy, areas of necrosis covered with black scabs are detected on the mucous membrane. A biopsy reveals fungal hyphae. With mold mycoses, a viscous secretion is formed, sometimes jelly-like, yellowish or gray-white.

Treatment consists of excision of the affected tissue and intravenous administration of the antifungal drug Amphotericin.

When infected with Aspergillus, the mycetoma is gray in color with inclusions in the form of black dots. When affected by candida, yellowish cheesy masses form in the cavity.

In people with normal immunity, the disease progresses slowly and has a torpid course.

Rice. 12. Endoscopic picture of chronic sinusitis of fungal nature.

Rice. 13. Chronic sinusitis. Mycetoma in the maxillary sinus (endoscopic picture).

Allergic sinusitis

With increased sensitivity to certain environmental substances (allergies), allergic rhinitis develops and, as a result, allergic sinusitis. Allergens can be pollen from certain plants, dust mites, animal dander, food, etc. Triggers such as tobacco smoke and the odors of certain chemicals can have a powerful irritating effect.

The inflammatory effect is characterized by dilation of blood vessels and subsequent swelling of the mucous membrane, which leads to the development of symptoms of runny nose and itching, debilitating the patient. Violation of the outflow of sinus contents is characterized by symptoms such as pain and a feeling of fullness in the face.

There are indirect signs of sinusitis, indicating its allergic nature:

• upon examination, not local, but diffuse swelling of the nasal turbinates is noted,
• the inferior nasal concha is pale in color,
• discharge from the nasal passages is light in color and foamy in nature.

Rice. 14. Allergic rhinitis. Swelling of the mucous membrane causes difficulty breathing.

Allergic sinusitis often occurs in people suffering from bronchial asthma and hay fever.

Diagnosis of the disease

Sinusitis is often well diagnosed. In most cases, a correctly collected medical history and examination of the patient (rhinoscopy) is sufficient to make a diagnosis.

A detailed study is necessary to diagnose chronic asymptomatic sinusitis, post-traumatic and fungal in nature. In-depth diagnosis in this case will be the key to prescribing adequate therapy and cure.

If the diagnosis after examination is still unclear or antibiotic treatment has not yielded results, or if complications occur, additional examination is required.

Rhinoscopy

Rhinoscopy is the first and important method for objective diagnosis of sinusitis. An anterior rhinoscopy is performed. The disease reveals hyperemia, swelling of the nasal mucosa, narrowing of the nasal passages, discharge from the mouth of the maxillary sinus, and the nature of the secretion.

Rice. 15. The photo shows a doctor performing rhinoscopy. With its help, you can identify not only the first signs of the disease, but also find out its cause.

X-ray examination

An X-ray examination will reveal all the dense structures inside the maxillary sinus: secretion (gives a horizontal level in the cavity in a sitting position), thickened mucous membrane, thickened or destroyed bone wall, polyps, cysts and neoplasms. A clear contour of the walls and a uniform decrease in transparency indicate acute sinusitis. If, along with a decrease in the transparency of the maxillary sinus, a thickening of its side wall is noted, then they speak of chronic sinusitis. If a fistula has formed as a result of chronic sinusitis, then the identification of a bone defect in the wall of the sinus is diagnosed by inserting a probe into the fistula tract.

X-ray examination is inferior in information content to computed tomography.

Rice. 16. In the photo on the left there is a normal appearance of the maxillary sinuses (x-ray). In the photo on the right - left-sided sinusitis (direct nasomental projection).

Rice. 17. On the radiograph, liquid pus has a horizontal level.

Rice. 18. Total darkening of the left maxillary sinus.

Computed and magnetic resonance imaging (CT and MRI)

Computed tomography is the “gold standard” in the diagnosis of not only sinusitis, but also all other types of sinusitis. This research method has increased accuracy and sensitivity. Using CT, the size of the sinuses, the volume of secretions and the presence of complications are determined. CT and MRI are indispensable for injuries (foreign bodies and fractures) and for identifying palpous growths and neoplasms.

Magnetic resonance imaging (MRI) is of less importance in diagnosing the disease. This is due to the fairly high frequency of overdiagnosis.

Using CT and MRI, the size of the sinuses, the volume of secretions, and the presence of complications are determined; these techniques are indispensable for injuries and detection of tumors.

Rice. 19. Computed tomography is the “gold standard” in diagnosing types of sinusitis.

Rice. 20. Photo of color MRI. The hypertrophied mucous membrane of the maxillary sinuses is indicated in blue; the blocked nasal passage is on the right.

Endoscopic diagnostics

Endoscopic diagnostics are carried out in a hospital setting and require special equipment and trained personnel. The procedure is used to examine the nasal cavity, nasopharynx, anastomosis and sinuses.

Rice. 21. Photo of nasal polyps taken during endoscopy.

Therapeutic and diagnostic puncture

Therapeutic and diagnostic puncture is used to extract the contents of the maxillary sinus, followed by histological and bacteriological examination of the material and determination of sensitivity to antibacterial drugs. The therapeutic and diagnostic puncture ends with the action of drugs on the sinus mucosa - antibiotics, corticosteroids, antiseptics and enzymes.

The puncture is carried out under local anesthesia with a special needle, which pierces the wall of the maxillary sinus through the nasal passage in the thinnest place.

This type of study is used in children over the age of 6 years.

Rice. 22. Therapeutic and diagnostic puncture is practically painless, as it is performed under local anesthesia.

Therapeutic and diagnostic puncture of the maxillary sinus is the most effective diagnostic and therapeutic technique currently used in our country

Ultrasonography

Ultrasound examination is a fast, non-invasive method. An ultrasound examination of the paranasal sinuses can determine whether or not there are pathological changes in the maxillary cavities. In the absence of pathology, you can continue the search for the causes of the disease in another direction. If there are signs of sinusitis, an x-ray examination is started. This technique requires trained personnel.

This technique requires trained personnel.

Bacteriological diagnostics

For bacteriological examination, it will be necessary to collect the mucous contents of the nasal cavity and sinuses, followed by the isolation of pathogens - bacteria and fungi, and a test for sensitivity to antibiotics. There is information that the microflora of the nose and pharynx is not identical, which must be taken into account when selecting an antibiotic for a patient. Microbiological examination of nasal and pharyngeal mucus must be carried out separately.

Skin tests for allergies

If allergic sinusitis is suspected, skin tests should be performed.

Differential diagnosis

Symptoms and signs of sinusitis can be observed with the development of benign and malignant tumors, as well as with a destructive polyposis process.

Rice. 23. Methodology for ultrasound examination of the maxillary sinuses.

Content

With chronic runny nose, a disease called “Sinusitis” develops, which is accompanied by filling of the maxillary sinuses with mucous contents. The characteristic disease is characterized by a protracted course. Treatment of the pathology can be conservative, but doctors do not rule out surgical intervention. The disease requires consultation and participation of an otolaryngologist.

What are the maxillary sinuses

This structure of the respiratory system is also called the maxillary cavity. It is structurally divided into right and left. Such an air cavity contains a mucous membrane consisting of nerve endings, choroid plexuses, mucous glands, and performs a respiratory and protective function. When dangerous pathogens and pathogenic microbes penetrate the maxillary sinuses, an inflammatory process occurs, which urgently needs treatment with antibiotics.

Anatomy

The maxillary sinuses are paired cavities, present on the right and left sides. Structurally, there are the following components: two frontal sinuses above the orbit, the same number of ethmoid sinuses to separate the nasal cavity from the brain, anastomosis of the sphenoid sinus, one sphenoid cavity, anastomosis of the maxillary sinus. The inflammatory process can affect any part of the respiratory system, resulting in impaired breathing and weakened immune functions. Diseases occur in childhood and adulthood and require timely medical attention.

Location

Photos of patients on medical forums on the Internet clearly show what the maxillary sinus looks like and where it is located. There is a characteristic structure above the molars of the upper jaw, and it has upper, lower, anterior, medial and posterior walls, and epithelial cilia to perform a transport function. Since the mucous membrane contains a minimal number of nerves, goblet cells, and vessels, there is no pain during sinusitis, and the disease at the initial stage is asymptomatic.

Functions

Knowing where the maxillary sinus is located, it is necessary to find out in detail why such a structure is needed and what functions it is characterized by. This once again proves that it is necessary to take preventive measures in time, to pay special attention to the first symptoms of an unpleasant disease, for example, if a runny nose suddenly appears or discharge of suspicious fluid or mucus from the nasal passages. The action of the maxillary sinuses in the respiratory system is as follows:

1. Sound. Increased vocal resonance.
2. Baroreceptor. Increasing the sensitivity of the senses to environmental pressure.
3. Structural. Giving the frontal bone a special shape.
4. Protective. Thanks to the cilia of the epithelium, rapid removal of pathogenic flora is ensured.
5. Buffer. Protection of the facial bone from injury, impact, and other mechanical damage.

Inflammation of the maxillary sinuses

In case of allergies or penetration of pathogenic flora, an inflammatory process of the maxillary sinuses is observed, which is the main symptom of an unpleasant disease of the respiratory system. If not treated in time, unpleasant symptoms increase rapidly, and more serious complications for the respiratory system and the entire body cannot be ruled out. The patient should be alert to nasal congestion and pus in the sinuses. This is how acute sinusitis develops, requiring immediate examination.

The mechanism of the inflammatory process during sinusitis is as follows: under the influence of a pathogenic infection in the maxillary sinuses, there is a deterioration in the outflow of mucus and the inflow of the sinus. As a result of such an imbalance, fluid stagnation begins, the formation of mucus with its further difficult removal. The maxillary sinuses fill up even more. In this case, the mucus gradually thickens, dangerous purulent masses form, and a total darkening of the maxillary sinuses is possible. Soon an adult or child notices that their sinuses hurt and timely treatment is required.

Causes of sinusitis

Before using official or alternative intensive care methods, it is important to understand the etiology of the pathological process and eliminate the pathogenic factor of sinusitis. Essentially, this is an internal runny nose that interferes with breathing, but does not go out. The main causes of pathology are increased activity of streptococci, staphylococci, fungal infections, other harmful microorganisms and allergens. If nothing is done, the disease becomes chronic and cannot be treated.

The following factors of the body and environment can become prerequisites for the development of sinusitis:

• weakened immune system;
• physiological curvature of the nasal septum;
• bad habits;
• prolonged hypothermia of the body;
• allergic reaction;
• chronic rhinitis, tonsillitis, stomatitis;
• water sports;
• lack of timely treatment of acute respiratory viral infections, acute respiratory infections;
• seasonal development of the disease;
• genetic predisposition;
• infection by microbes by airborne droplets.

Signs

If the maxillary sinuses are inflamed, the patient cannot breathe fully. Signs of a characteristic pathology especially increase in the evening, during sleep. To restore the functioning of the affected sensory organ, it is necessary to undergo a detailed examination, and it is mandatory to take an x-ray to visualize the source of the pathology. To collect medical history data, you should pay attention to the following symptoms of sinusitis:

• more frequent migraine attacks;
• unpleasant odor from the mouth and nose;
• swelling of the ears, face, neck;
• soreness of the nasal mucosa;
• discharge of purulent or liquid mucus;
• general weakness, passivity;
• increased body temperature;
• impaired breathing;
• decreased appetite, sleep phase duration;
• prolonged nasal congestion.

Forms of sinusitis

In every clinical case of sinusitis, there is an increased accumulation of mucus, which fills the maxillary sinuses and disrupts normal breathing. Treatment is administered depending on the nature of the pathology, etiology and modification. In the latter case, otolaryngologists identify the following forms of sinusitis, which are equally prevalent in childhood and adulthood:

1. Acute sinusitis is accompanied by a jump in temperature, pain under the eyes, nasal congestion, and mucus from the nasal passages.
2. Chronic sinusitis is characterized by increased unpleasant symptoms at night, the presence of a severe cough, and recurrent rhinitis.
3. Purulent sinusitis is accompanied by the formation of pus, which first fills the purulent cavities and is then discharged out.
4. Catarrhal sinusitis is characterized by the formation of gray contents in the maxillary cavities with further removal to the outside.

Treatment

If the maxillary sinuses are filled with mucus, it is important to start treatment in a timely manner, but first take an x-ray. When visualizing the affected area, the attending physician recommends taking antibiotics to effectively destroy the pathogenic flora, other medications to relieve the unpleasant symptoms of sinusitis, and physiotherapeutic procedures to restore the affected tissues and the usual functions of the sensory organ. In complicated clinical situations, surgical intervention is appropriate.

Medicines

The approach to the emerging health problem is complex and includes several pharmacological groups to alleviate the general condition of the clinical patient. The regimen of conservative therapy depends on the etiology of the pathological process and does not exclude the use of antibacterial drugs. To effectively eliminate discomfort, doctors offer the following medications, according to the patient’s age category:

• vasoconstrictor sprays and drops, if the maxillary sinuses have become swollen: Otilin, Nazivin, Nasonex, Rinazolin, Dlyanos;
• antibiotics to destroy pathogenic flora and alleviate the patient’s general condition: Augmentin, Azithromycin, Amoxiclav, Cephalosporin;
• antihistamines to suppress allergy symptoms: Cetrin, Suprastin, Tavegil, Supradin, L-cet.

Washing the maxillary sinuses at home

Conservative treatment methods are complemented by physiotherapeutic procedures at home. For example, to rinse the nasal passages, you can use special medications, including Aquamaris, Humer, Marimer, Aqualor. As an alternative to such expensive treatments, it is recommended to use a salt water solution prepared at home.

You need to start the procedure by purchasing a thick syringe without a needle, which you first need to fill with a saline composition, and then direct the flow into one nasal passage. Keep your head tilted at the same time. Liquid flows into one nostril and flows out of the other. Carry out similar manipulations with the second nasal passage, effectively ridding the maxillary sinuses of purulent contents. Instead of a saline solution, you can use formulations with the addition of essential oils, for example, eucalyptus.

Warming up

Water procedures at elevated temperatures successfully treat inflamed maxillary sinuses. Steam, penetrating into narrowed openings, productively relieves inflammation, expands vascular walls, normalizes impaired breathing, and ensures high-quality cleansing of mucus and stagnation products. The long-awaited period of remission occurs, and the nights become calm, the sleep phase is extended. You can boil the salt or potato composition; the use of alkaline solutions is allowed. To improve local blood circulation, it is allowed to use “Asterisk”.

Burying

Sinusitis is associated with a prolonged runny nose, therefore, at the first symptoms of such ailment, it is recommended to buy vasoconstrictor drops or sprays at the pharmacy. Use according to the instructions; before starting the course, be sure to consult with your doctor. The following medications have proven themselves well in this area: Vibrocil, drops with menthol or olive oil.

Folk remedies

You can successfully treat the maxillary sinuses using alternative medicine methods, for example, make two identical tampons from cotton wool, moisten them with olive oil with a few drops of propolis or fresh aloe juice, and then place one homemade turunda in each nasal passage for 15-20 minutes. Inflammation of the ducts goes away after the first procedure, but doctors strongly recommend consolidating the results. Other folk remedies have proven themselves well:

1. Squeeze the juice of aloe and celandine. Take the ingredients in equal proportions, add the same amount of liquid honey, mix. Place 5-7 drops in each nostril in the morning and evening for 10 days.
2. Heat water in a saucepan, then pour half a bottle of propolis tincture into the liquid. Stir and cover with a lid. After a couple of minutes, cover your head with a towel, open the lid and breathe heavily in the healing vapors.

Prevention of inflammation of the maxillary sinuses

To avoid the inflammatory process, you need to be vigilant about your own health, regularly take vitamins and strengthen your immune system. Mandatory measures to prevent sinusitis are as follows:

• avoid prolonged hypothermia;
• ensure high-quality hygiene of the nasal passages;
• spend more time in the fresh air, eat right;
• avoid close contact with sick people;