Air Sinuses

Embed Size (px)

Citation preview

  • 8/3/2019 Air Sinuses

    1/107

    www.similima.com 1

    AIR SINUSES

  • 8/3/2019 Air Sinuses

    2/107

    www.similima.com 2

    Topics covered

    What is sinus?

    Classification History Development Classification PNS

    Functions

    MAXILLARY SINUS FRONTAL SINUS ETHMOID SINUS SPHENOID SINUS

    Blood supply

    Lymphatic drainage

    Nerve supply

    Microcsopic anatomy Osteomeatal complex

    Drainage of sinus

    Sinusitis

    Predisposing factors

    Causes

    Types

    Pathology

    C/F

    Routes of spread

    Complications

    Diagnosis

    Surgical intervention

    D/D

    Prevention

  • 8/3/2019 Air Sinuses

    3/107

    www.similima.com 3

    a hollow, cavity, recess, or pocket ,such as air-filled cavity in a dense portion of a skull bone

    a large channel containing blood

    a tract or fistula leading to a cavity which maybe filled with pus

    a channel permitting the passage of blood orlymph that is not a blood vessel or lymphaticvessel, such as the sinuses of the placenta.

    What is a sinus?

  • 8/3/2019 Air Sinuses

    4/107

    www.similima.com 4

    Classification

    Sinus

    Bloodfilled

    Airfilled

  • 8/3/2019 Air Sinuses

    5/107

    www.similima.com 5

    Air sinus is an aircontaining space within abone

  • 8/3/2019 Air Sinuses

    6/107

    www.similima.com 6

    PARANASAL SINUSES

    4 paired sets of air-filled cavities ofcranio-facial complex surrounding theeyes and nose & are lined with mucus-

    producing membranes.

  • 8/3/2019 Air Sinuses

    7/107

    www.similima.com 7

    PARANASAL SINUSES

    Each sinus is named after the bone itresides in

    Frontal

    Ethmoidal

    Maxillary

    Sphenoidal

  • 8/3/2019 Air Sinuses

    8/107

    www.similima.com 8

    History Galen (2oo) described the

    presence of the ethmoid air cells.

    descriptions of the maxillarysinuses by Leonardo da Vinci(1489)

    the sphenoid sinuses by GiacomoBerengario da Carpi (1521)

    the frontal sinuses by Coiter(16th century)

    The first modern and accuratedescriptions by Austriananatomist Emil Zuckerkandl.

  • 8/3/2019 Air Sinuses

    9/107

    www.similima.com 9

    Mesenchyme Tissue

    Ethmoidoturbinal -> middle, superior,and supreme turbinates

    Maxilloturbinal outgrowth -> inferiorturbinate

    development of - agger nasi cells

    uncinate processethmoid infundibulum

    sinuses then begin to develop

    NORMAL DEVELOPMENT

  • 8/3/2019 Air Sinuses

    10/107

    www.similima.com 10

    Sinuses start as small sacs aroundnasal meatus and ressesses

    Grow -> invading bone -> forming airsinuses & cells

    NORMAL DEVELOPMENT

  • 8/3/2019 Air Sinuses

    11/107

    www.similima.com 11

    Maxillary At birth -> 3 yrs

    Frontal 2 - 9 yrs

    Sphenoids 6 7 yrs

    Ethmoids At birth -> puberty

    All fully developed by age 17-18

  • 8/3/2019 Air Sinuses

    12/107

    www.similima.com 12

    http://catalog.nucleusinc.com/enlargeexhibit.php?ID=3660
  • 8/3/2019 Air Sinuses

    13/107

    www.similima.com 13

    AIR SINUS

    ANTERIOR POSTERIOR

    FRONTAL MAXILLARYANT.

    ETHMOIDALSPHENOIDAL

    POST

    . ETHMOIDAL

  • 8/3/2019 Air Sinuses

    14/107

    www.similima.com 14

    Functions of para nasal sinuses

    Not definitely known! but speculated:

  • 8/3/2019 Air Sinuses

    15/107

    www.similima.com 15

    Functions of para nasal sinuses

    Lightening the skull. Add resonance to speech Humidifying and warming inspired air

    Regulation of intranasal pressure Increasing surface area of olfaction Contribute to facial growth Act as airbags in trauma - Absorbing

    shock Possibly controls immune system?

  • 8/3/2019 Air Sinuses

    16/107

    www.similima.com 16

    MAXILLARY SINUS

    Largest PNS

    Paired

    Pyramidal in shape

    Capacity 30 ml

    Base pointing tolateral wall of nose

    Apex laterally inzygomatic process

  • 8/3/2019 Air Sinuses

    17/107

    www.similima.com 17

    Relations Maxillary sinus

    Ant acia sur ace omaxilla

    Post infratemporal &pterygopalatine fossa

    Medial- middle & inferiormeatus

    Floor- alveolar& palatine

    Roof- floor of orbit

  • 8/3/2019 Air Sinuses

    18/107

    www.similima.com 18

    Important to dentist

    .bc of proximity of teeth and theirassociated structures

  • 8/3/2019 Air Sinuses

    19/107

    www.similima.com 19

    FRONTAL SINUS

    Resides in frontalbone

    2 nd largest

    Assymmetrical

    Usually paired-sometimes 1, 3 ornone!

  • 8/3/2019 Air Sinuses

    20/107

    www.similima.com 20

    Relations Frontal sinus

    Ant- skin over theforehead

    Inf- orbits & its cont

    Post- meningeal andfrontal lobe of brain

  • 8/3/2019 Air Sinuses

    21/107

    www.similima.com 21

    Ethmoid sinus

    within the ethmoidallabyrinth of the lateralmass of ethmoid bone

    divided into1. Anterior2. Middle

    3. Posterior groupsaccording to the areaof drainage

  • 8/3/2019 Air Sinuses

    22/107

    www.similima.com 22

    Ethmoid sinus - Relation

    lies b/w the upperpart of nasal cavity&orbits (2) and isseparated from the

    orbit by a thinorbital plate ofethmoid laterally.

    Below is the part of

    maxillary airsinus(4)and superiorly isthe anterior part offrontal sinus (1)

  • 8/3/2019 Air Sinuses

    23/107

    www.similima.com 23

    Sphenoid Sinus

    Resides in body ofsphenoid

    May be single orpaired

    Assymmetrical Not present at birth

    Lies below to sella

    tursica Related tooptic tract, chiasma,internal carotid artery

  • 8/3/2019 Air Sinuses

    24/107

    www.similima.com 24

    Sphenoid Sinus - Relation

    Pituitary gland liesabove the sphenoidsinus

    Optic nerve andinternal carotidarteries traverse itslateral wall

    The nerve ofpterygoid canal liein the floor of thesinus

  • 8/3/2019 Air Sinuses

    25/107

    www.similima.com 25

    Blood supply

    Ethmoid -

    Sphenopalatine art

    Ant & posterior

    ethmoidal artery

    Maxillary -

    facial, infra orbital,greater palatine art

  • 8/3/2019 Air Sinuses

    26/107

    www.similima.com 26

    Blood supply

    Sphenoid sinus

    post ethmoidal art

    Frontal

    Supra orbital art

    ant ethmoidal

  • 8/3/2019 Air Sinuses

    27/107

    www.similima.com 27

    Lymphatic drainage

    ANTERIORMaxillary

    Frontal

    Ethmoid- ant,middle

    submandibularnodes

    SUBMANDIBULAR

  • 8/3/2019 Air Sinuses

    28/107

    www.similima.com 28

    Lymphatic drainage

    POSTERIOR

    Post ethmoidSphenoid

    retropharyngeal nodes

    http://en.wikipedia.org/wiki/File:Illu_quiz_hn_03.jpg
  • 8/3/2019 Air Sinuses

    29/107

    www.similima.com 29

    NERVE SUPPLY

    Maxillary- infra orbitalalveolar nerves (ant, middle, post sup)

    Frontal - Supra orbital nervetraversing the floor of

    the sinus

    Ethmoid - Ant and post ethmoidal nerves.Orbital br of pterygopalatine ganglion

    Sphenoid - post ethmoidal nerve

  • 8/3/2019 Air Sinuses

    30/107

    www.similima.com 30

    MICROSCOPICANATOMY

  • 8/3/2019 Air Sinuses

    31/107

    www.similima.com 31

    Lined by mucusmembrane

    Ciliated columnarepithelium

    Goblet cellssecretes mucus

    Cilia are marked

    near ostia

  • 8/3/2019 Air Sinuses

    32/107

    www.similima.com 32

    Cilia 9+2

  • 8/3/2019 Air Sinuses

    33/107

    www.similima.com 33

    epithelial lining has acilium - relatively longstructure -> push sinus

    mucus.

    mucociliary clearance isprogrammed , so mucus

    moves along in a specificpattern.(About ltr per 24 hr !)

  • 8/3/2019 Air Sinuses

    34/107

    www.similima.com 34

    The sinus doesnot drain by gravity - it is anactive process.

  • 8/3/2019 Air Sinuses

    35/107

    www.similima.com 35

    Ostiomeatal complex

    All sinus open into middle meatus exceptpost ethmoid & sphenoid sinus

    The openings of the sinus ostia into themiddle meatus are close together andform the ostio-meatal complex

    Functional reln between the space andthe ostia that drain into it

  • 8/3/2019 Air Sinuses

    36/107

    www.similima.com 36

    This is a key area

    because pathology inthis region caninterfere withventilationand mucociliaryclearance of thesinuses. Prolongedobstruction of theseostia during prolonged

    nasotrachealintubation can lead onto chronic sinusitis

  • 8/3/2019 Air Sinuses

    37/107

    www.similima.com 37

    Ostium: opening within themaxillary sinus

    Uncinate process: sickleshaped bone extension ofthe medial wall

    Infundibulum: the canal

    like structure

    Hiatus semilunaris: slit likeair space

    Bulla ethmoidalis: largest

    ethmoidal bulla

    Middle meatus: wherehiatus semilunaris opens

    ostium

    infundibulumB E

  • 8/3/2019 Air Sinuses

    38/107

    www.similima.com 38

    1) SS sphenoethmoid recess

    2) FS infundibulum of middle

    3) Ant ES / infundibularinfundibulum of middle

    4) middle ES / Bullar sinus ethmoid bulla of middle

    5) MS middle meatus

    (posterior ethmoid cells superior)

    DRAINAGE OF SINUSES

    SS

    FS

    ES

  • 8/3/2019 Air Sinuses

    39/107

    www.similima.com 39

    One other structure

    empties into the nasalcavity and the is the

    nasolacrimal duct.

    This duct carries awayextra tears.

    when the drainagepores are closed off dueto irritation, they fill upand cause pressure

    which can then causeheadaches (sinusheadaches).

  • 8/3/2019 Air Sinuses

    40/107

    www.similima.com 40

    APPLIED ANATOMY

  • 8/3/2019 Air Sinuses

    41/107

    www.similima.com 41

    Paranasal sinuses are joined to nasalcavity via small orifices called Ostia

    Ostia easily blocked -> drainage ofmucus is disrupted

    Sinusitis may result

    Latin word SINUO = bend, wind, curve

    http://clear.msu.edu/dennie/clipart/headache.gif
  • 8/3/2019 Air Sinuses

    42/107

    www.similima.com 42

    SINUSITIS

    It is a condition of infection orinflammation of PNS, which may or may

    not be a result of infection, frombacterial, viral, fungal, allergic or

    autoimmune issues.

    http://clear.msu.edu/dennie/clipart/headache.gif
  • 8/3/2019 Air Sinuses

    43/107

    www.similima.com 43

    Maxillary > ethmoid > frontal > sphenoid

    All sinuses affected

    Pansinusitis

  • 8/3/2019 Air Sinuses

    44/107

    www.similima.com 44

    Predisposing factors

    Allergies

    Asthma

    DNS Small sinus ostia

    Smoking

    Nasal polyps

    Cystic fibrosis -thick mucus

  • 8/3/2019 Air Sinuses

    45/107

    www.similima.com 45

    Mallus.

    River bath Oil bath

    Change of weather

    Humid climateSea air

    Pollution

    Two wheeler

    Allergies from pets

  • 8/3/2019 Air Sinuses

    46/107

    www.similima.com 46

    SINUSITISCause of a/c sinusitis

    Virus

    Bacteria

    Fungus

    Nose blowing

    Scuba diving Foreign body

    Medications

    Dental infections

    Trauma

    Adenoids & tonsillitis

    DNS , polypi ,beneign tumours

    Cause of c/c sinusitis

    Allergies

    Fungus

    Unresolved a/c sinusitis

    Asthma

    Temp & humidity Narrow sinuses

    Defective m m

    Dehydration

    Poor air quality

    Weak immune system Hormones & stress

    Polyps & tumours

  • 8/3/2019 Air Sinuses

    47/107

    www.similima.com 47

    Viral Rhinosinusitis

    Most URTI are viral

    Short lived, lasts less than 10 days

    Sinus mucosa & nasal mucosa isinvolved

  • 8/3/2019 Air Sinuses

    48/107

    www.similima.com 48

    Classification of Bacterial Sinusitis

    a/c < 4 weeks Resolvecompletely

    Sub a/c 4 - 12 weeks Resolvescompletely

    c/c > 12 weeks

    http://friartuc.files.wordpress.com/2009/05/bulldog-with-headache.jpg
  • 8/3/2019 Air Sinuses

    49/107

    www.similima.com 49

    Chronic Sinusitis

    Symptoms present longer than 8 weeksin adults or 12 weeks in children

    Eosinophilic inflammation or chronicinfection

    Associated with positive CT scans

    B t i I l d i Ch i

    http://friartuc.files.wordpress.com/2009/05/bulldog-with-headache.jpghttp://friartuc.files.wordpress.com/2009/05/bulldog-with-headache.jpg
  • 8/3/2019 Air Sinuses

    50/107

    www.similima.com 50

    Bacteria Involved in ChronicSinusitis

    Role of Viruses is Unknown

    Streptococcus pneumoniae

    Haemophilus influenza

    Moraxella catarrhalis

    Staph aureus

    Coagulase negative staphylococcus

    Anerobic bacteria

  • 8/3/2019 Air Sinuses

    51/107

    www.similima.com 51

    Fungal sinusitis

    Patients with Diabetes orimmune defeciencies

    Aspergillus - temperate

    climate

    mouldy work atmosphere

    Mucor species

    Life threatening

  • 8/3/2019 Air Sinuses

    52/107

    www.similima.com 52

    Paediatric sinusitis

    R/c cold , allergy

    Intake of cold food

    Foreign bodies in nose Influenza

    Measles

    Adenoids

    Living in congested area, unhygeinicenv

    http://s2.hubimg.com/u/1087905_f260.jpghttp://www.clipartguide.com/_pages/0511-0906-2321-1304.html
  • 8/3/2019 Air Sinuses

    53/107

    www.similima.com 53

    PATHOLOGY

    Mucus membrane affected

    Secretions -> purulent

    Increased ciliary movement -> ineffective-> destruction

    Proliferation of mm

    Thickening of memb -> polyps

    Infection -> submucus layer -> bone

    Fibrous tissue, new bone formation

    http://www.clipartguide.com/_pages/0511-0906-2321-1304.html
  • 8/3/2019 Air Sinuses

    54/107

    www.similima.com 54

    CLINICAL FEATURES

    a/c sinusitis c/c sinusitis

    Vacuum headache

    Systemic malaise,

    bodyache, fever

    MM of nose red &oedematous

    Pus from correspondingoutlets

    Headache

    Facial fullness < bending

    Fever

    Hoarseness

    Halitosis

    Nasal obstruction

    Nasal discharge - purulent

    PND

    Abnormalities of smell

    Epistaxis

    r/c sore throat

  • 8/3/2019 Air Sinuses

    55/107

    www.similima.com 55

    Frontal Above eyes

    < morning

    Swelling ofupper eyelid

    Ethmoidal Deep behindeyes

    Medial canthus

    Maxillary Localised toupper teeth

    < noon

    Lower eyelid

    Sphenoidal Deep seatedcentral pain

    Vertex / occiput

    Blockage of frontonasal duct -> air absorbed -> hyperaemia -> HA

  • 8/3/2019 Air Sinuses

    56/107

    www.similima.com 56

    Routes of spread

    Dehiscences and weak bony barriers

    Floor of the frontal sinuses form the roof of the orbit

    (Infraorbital canal)

    Thrombophlebitis via diploic veins present in the frontalbone - veins of Breschet.

    Venous connections between the sinuses and the orbitdonot have any valves

    The roots of the second premolar and the first upper molarare intimately related to the floor of the maxillary sinus.

  • 8/3/2019 Air Sinuses

    57/107

    www.similima.com 57

    Predisposing factors forcomplications

    Immunocompromised patient (e.g. HIV)

    Diabetes mellitus

    Irregular treatment for sinus infections

  • 8/3/2019 Air Sinuses

    58/107

    www.similima.com 58

    ORBITAL COMPLICATIONS

    Orbital cellulitis &abscess

    Blindness compression of opticcanal

    Optic neuritis

    infection thru duralsheath of optic N

  • 8/3/2019 Air Sinuses

    59/107

    www.similima.com 59

    INTRACRANIAL COMPLICATIONS

    Meningitis thrombophlebitis

    Brain abscess

    Cavernus sinus thrombosis

    CSF rhinorrhoea from blowing nose

    Persisting HA

    Defects in memory, behaviour

  • 8/3/2019 Air Sinuses

    60/107

    www.similima.com 60

    Osteomyelitis

    Pott's puffy tumor: oeteomyelitis of frontalbone

    Fractures Mucocoele

    Cysts

    Fistula

    Malignancies Tumours

    Kartageners syndrome

    OTHER COMPLICATIONS

  • 8/3/2019 Air Sinuses

    61/107

    www.similima.com 61

    DIAGNOSIS

    Duration of s/s

    Diagnostic Nasal Endoscopy (DNE)-congestion & mucopus

    CT scan Echosinography

    Diagnostic proof puncture

    Tissue sample for histology & culture Multiple biopsy

    Transillumination maxillary & frontal

  • 8/3/2019 Air Sinuses

    62/107

  • 8/3/2019 Air Sinuses

    63/107

    www.similima.com 63

    Waters View

    W i

  • 8/3/2019 Air Sinuses

    64/107

    www.similima.com 64

    Waters view ( occipitomental )

  • 8/3/2019 Air Sinuses

    65/107

    www.similima.com 65

  • 8/3/2019 Air Sinuses

    66/107

    www.similima.com 66

    ELICITING SINUS TENDERNESS

    Frontal sinuses by pressing the fingerupward beneath the medial end of thesuperior orbital margin.

    Ethmoidal sinuses with the thumb inthe inner canthus of one eye and theindex finger in the other and pushingposteriorly, posterior to the lachrymalbone and squeezing.

    Maxillary sinus by pressing the fingeragainst the ant wall of maxilla belowthe inf orbital margin

  • 8/3/2019 Air Sinuses

    67/107

    www.similima.com 67

    Surgical intervention

    Trephening of the frontal sinus for a/c sinusitis through floor of the frontal sinus above the innercanthus

    Antrum puncture

    Intra nasal antrostomy

    Caldwell-LUC operation

    Balloon catheter dilation of paranasal sinus for chronicsinusitis

  • 8/3/2019 Air Sinuses

    68/107

    www.similima.com 68

    D/D

    Allergic rhinitis

    Bronchitis

    Rhinoviral infections

    Upper respiratory infection Cystic fibrosis (especially in children with polyps)

    HIV infection

    Wegener's granulomatosis

    Tumors Mucor Mycosis

    Migraine

  • 8/3/2019 Air Sinuses

    69/107

    www.similima.com 69

    Differentiating Sinusitis from Rhinitis

    Sinusitis

    Nasal congestion

    Purulent rhinorrhea

    Postnasal drip

    Headache

    Facial pain

    Anosmia

    Cough, fever

    Rhinitis

    Nasal congestion

    Rhinorrhea clear

    Runny nose

    Itching, red eyes

    Nasal crease

    Seasonal

    symptoms

  • 8/3/2019 Air Sinuses

    70/107

    www.similima.com 70

    PREVENTION

  • 8/3/2019 Air Sinuses

    71/107

    www.similima.com 71

    For sinus pain or pressure

    Avoid flying when you are congested

    Avoid temperature extremes

    Avoid sudden changes in temperature

    Avoid bending your head down

  • 8/3/2019 Air Sinuses

    72/107

    www.similima.com 72

    Apply a warm, moist washcloth to yourface several times a day

    Drink plenty of fluids to thin the mucus

    Inhale steam 2 - 4 times per day

    nasal saline several times per day

    Use a humidifier?

    Saline rinse - one cup of warm water +

  • 8/3/2019 Air Sinuses

    73/107

    www.similima.com 73

    Saline rinse one cup of warm water +

    1/4 teaspoon of non-iodized salt + teaspoon of baking soda

    Discontinue eating milk

    and cheese

    since dairy products contribute to

    mucus production in the body

  • 8/3/2019 Air Sinuses

    74/107

    www.similima.com 74

    Avoid substances that dehydrate the

    body - spicy foods, alcoholic

    beverages, tea and coffee

    Avoid excessive forceful nose-blowing

    Avoid swimming or diving, which canput undue pressure on the sinuses

  • 8/3/2019 Air Sinuses

    75/107

    www.similima.com 75

    Frontal sinus

    Supra orbital nerve referred pain overskin of forehead upto vertex

    Drains close to maxillary sinus orifice

    infection spreads easily

    Brain abscess in frontal lobe

  • 8/3/2019 Air Sinuses

    76/107

  • 8/3/2019 Air Sinuses

    77/107

    www.similima.com 77

    Ethmoid sinus

    Fragile medial wall of orbit blindness& optic neuritis

    Common in paediatric age group

    Common site of # - CSF Rhinorrhoea

  • 8/3/2019 Air Sinuses

    78/107

    www.similima.com 78

    Sphenoid sinus

    Spread upward in front of pituitary

    affects optic chiasma

    disturbed vision

  • 8/3/2019 Air Sinuses

    79/107

    www.similima.com 79

    Other Diseases Affecting Sinuses

    MucocoeleCysts

    Oro antral fistulaTumours of the sinusesBarotraumaFractures

  • 8/3/2019 Air Sinuses

    80/107

    www.similima.com 80

    Mucoceles

    c/c cystic lesions esp in the frontal &ethmoid

    result of obstruction of the sinus ostium

    accumulation of secretions into anexpanding mass.

    Expansion and inflammation lead toremodeling and erosion of bone, whichchanges the bony architecture significantly.

    Usually contents of the mucocele are sterile

    If infected, then known as mucopyocele

  • 8/3/2019 Air Sinuses

    81/107

    www.similima.com 81

    Cysts

    more popularly known as nasal polyp

    soft and pearl-colored growths thatdevelop in the lining of the sinuses.

    in singles or clustered together

    by prolonged inflammation of the nasalpassages.

    Symptoms of allergies and asthma canalso lead to polyp formation.

  • 8/3/2019 Air Sinuses

    82/107

  • 8/3/2019 Air Sinuses

    83/107

    www.similima.com 83

    Tumours of sinuses

    BENIGN Transitional cell papilloma

    - Localised ivory osteoma

    - Cancellous osteoma

    MALIGNANT- Squamous cell carcinoma

  • 8/3/2019 Air Sinuses

    84/107

    www.similima.com 84

    Kartageners syndrome

    cilia are unable to move

    rare genetic birth defect

    Autosomal recessive

    Triad DextrocardiaBronchiectasis

    Sinusitis

    Primary ciliary dyskinesia /Immotile ciliary

    syndrome

    Afzelius syndrome /Zivert's syndrome

  • 8/3/2019 Air Sinuses

    85/107

    www.similima.com 85

    HOMOEOPATHY

  • 8/3/2019 Air Sinuses

    86/107

    www.similima.com 86

    MIASMATIC DIAGNOSIS

    Early stage psora

    R/c infection of sinus tubercular

    & sycosis

  • 8/3/2019 Air Sinuses

    87/107

    www.similima.com 87

    PSORA SYCOSIS SYPHILIS TUBERCULAR

    Rhinitis Sinusitis

    DNS,

    adenoids

    Deg &ulcerativecondn

    Epistaxis

    Nasal polyps

    Narrow nostrils

    a/c sympThin watery

    Moist snuffleswith purulentdge

    Clinkers withoffensiveness

    r/c & c/cEpistaxis

    PND

    < morning

    cold> NaturalDge

    < damp

    weather> Abn dge

    < nght

    warmth> Abn dge

    < closed room

    > Open air> epistaxis

  • 8/3/2019 Air Sinuses

    88/107

    www.similima.com 88

    MURPHYS REPERTORY

    Children - CATARRH, infants - sinuses,of

    Constitutions - INFANTS, constitutions -catarrh - sinuses, of

    Diseases - SINUSITIS, infection, nose

    Emergency - HEADACHES, severe,migraines - sinus, headache

    BBCR

  • 8/3/2019 Air Sinuses

    89/107

    www.similima.com 89

    BBCR

    NOSE - Internal sinuses

    PHATHAK

    N - Nose - sinuses

    S - Sinus affections, ofBOERICKE

    NOSE - Pain in - Pressing - in frontalsinuses

    NOSE - Sinuses

    NOSE - Sinuses - Catarrh of frontalsinuses

  • 8/3/2019 Air Sinuses

    90/107

    www.similima.com 90

    COMPLETE REPERTORY

    GENERALITIES - INFLAMMATION -chronic - sinusitis

  • 8/3/2019 Air Sinuses

    91/107

    www.similima.com 91

    SYNTHESIS

    GENERALS - HISTORY; personal -sinusitis; of recurrent

    GENERALS - INFLAMMATION - Sinuses;

    of GENERALS - INFLAMMATION - Sinuses;of - recurrent

    GENERALS - SINUSITIS

    GENERALS - SUPPRESSEDCOMPLAINTS; ailments from - sinusitis

  • 8/3/2019 Air Sinuses

    92/107

    www.similima.com 92

    Rare remedies

    Luffa operculata

    Abroma augusta folia

    Cassia sophera

    Granatum

    Erigeron Q

    Mucor mucido

    Distemberinumvaccinum

    Oscillococcinum Justisia adhatoda

    Berrylium mur

    Oxygenium

    Gallium sulph

    Tungstenium

    Cotyledon

    sinusitisinum

    Luffa operculata

  • 8/3/2019 Air Sinuses

    93/107

    www.similima.com 93

    Purulent sinusitis Frontal and occipital headache Acute or chronic inflammation of the mucous membranes

    in the nasal cavities Hypertrophy or atrophy of the nasal mucous membranes Violent headaches going from the forehead towards the

    nape of the neck Pain in the occipital region

    Frontal pains , with vertigo and muscae volitantes. Head cold , with pale or yellow nasal secretion , especiallyin the morning.

    Extreme hunger with emasciation Dryness of the nasal mucus, with sticky scab formations. < dry air in the closed room.

    > fresh air outdoors.

  • 8/3/2019 Air Sinuses

    94/107

  • 8/3/2019 Air Sinuses

    95/107

    www.similima.com 95

    Cassia sophera

    Dull pain in temporal and frontalregions < heat > Cold applicationbandage

    Desire for curd and pickles

    Desire for warm food and drinks eggs,sweet

    Appetite, diminished Weakness

    Granatum (pomgranate) vertigo

  • 8/3/2019 Air Sinuses

    96/107

    www.similima.com 96

    Granatum (pomgranate) vertigovermifuge

    OscillococciniumEspecially indicated in cases of INFLUENZA in persons wherethere is a carcinomatous background in the family-anamnesis, somewhat identical to Carcinosinum.Inflammatory reactions

    ll

  • 8/3/2019 Air Sinuses

    97/107

    www.similima.com 97

    Berryllium mur

    These people are very unsure ofthemselves. They don't know how tostand up for themselves, especially

    because they think that the otherperson will leave them if they do. Sothey tend to ignore their own needs toplease others; they come across as

    being kind and very easy going.

  • 8/3/2019 Air Sinuses

    98/107

    www.similima.com 98

    Chest radiography showing dextrocardia withaortic arch lying on right side of trachea with

  • 8/3/2019 Air Sinuses

    99/107

    www.similima.com 99

    aortic arch lying on right side of trachea withcystic bronchiectatic changes

  • 8/3/2019 Air Sinuses

    100/107

    www.similima.com 100

    Sinus polyp Oroantral fistula

  • 8/3/2019 Air Sinuses

    101/107

  • 8/3/2019 Air Sinuses

    102/107

    R l f NO i h t d f

  • 8/3/2019 Air Sinuses

    103/107

    www.similima.com 103

    Role of NO in host defence

    In nasal airways, continuous production of NO- indicated by presence of gas in nasallyderived air- In Kartagener's syndrome, pts lack NO innasal air & have severe problems withrecurrent airway infection

    epithelium in paranasal sinuses is a major site

    of NO production and suggest a role forairway-derived NO in primary host defence

    Structural theory:

  • 8/3/2019 Air Sinuses

    104/107

    www.similima.com 104

    Fallopio's theory: (1600) - Reducing the load on neckmusculature which supports the head

    maintenance of equilibrium and the positioning of the

    head Proetz theory: remodelling of facial bones

    Evolutionary theory: Evolutionary response of anthropomorphic monkeys to

    shift from terrestrial environment to the aquatic one

    By Hardy.

    Necessity to cross large stretches of water enabledthem to develop these air filled sinus cavities

    http://th02.deviantart.net/fs12/150/i/2006/312/0/c/Swimming_Monkeys_by_venkman_project.jpg
  • 8/3/2019 Air Sinuses

    105/107

    www.similima.com 105

    Functional theories:

    Bartholini's theory:

    As organs of resonance which

    added quality and resonanceto the voice

    Cloquet's theory:

    Paranasal sinuses contained olfactory epithelium aidingin the function of smell.

    http://www.arthursclipart.org/children/girlsbw/smell.gif
  • 8/3/2019 Air Sinuses

    106/107

    www.similima.com 106

    Sinuses improves nasal function:

    Embryological and histological continuity withthe nasal mucosa

    Additional secretion of lytic enzymes andimmunoglobulins.

    Ventilatory function:

    Gaseous exchange

    There is a pressure gradiant between thenasal cavity and para nasal sinuses causingairflow in to the sinus cavities

    T ansill mination of sin s

  • 8/3/2019 Air Sinuses

    107/107

    Transillumination of sinus