Rhinology and Facial Plastic Surgery

pp 189-201


  • Chris de SouzaAffiliated withState University of New YorkHealth Sciences Center, Louisiana State UniversityThe Tata Memorial Hospital, Lilavati Hospital, Holy Family Hospital
  • , Rosemarie A. de SouzaAffiliated withDepartment of Internal Medicine, Sion Hospital and LTMG Medical College

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■ Inflammation causes changes in the nasal and sinus mucosa.

■ Edema occurs and this is followed by a transudate. The effect of edema is that it causes obstruction of the ostia of the sinuses, thereby causing impairment in the drainage of secretions.

■ The quality of the mucus changes.

■ Inflammation causes the cilia to become paralyzed. This may be temporary or sustained, depending upon the severity of damage.

■ The outcome of all these changes is that mucus collects within the sinuses and stasis occurs.

■ Initially, the secretions are sterile. They can soon get contaminated with bacteria by nose-blowing, which forces the bacteria into the sinuses from the nasal cavity.

■ This results in an acute bacterial infection within the sinuses.

■ This can resolve either spontaneously or with the aid of medication. If it does not resolve it can result in chronic disease.

■ The criteria for the diagnosis of acute (presumed bacterial) rhinosinusitis include having symptoms that persist for 10 days up to a maximum of 24 days.

■ Fever should be present. Symptoms for diagnosis should include anterior and/or posterior nasal discharge, nasal obstruction, and facial pain.

■ Objective documentation should include a nasal airway examination for purulent discharge and radiographic evidence of acute rhinosinusitis.

■ Both nasal endoscopy and CT are objective measures that can increase the accuracy of the chronic rhinosinusitis (CRS) diagnosis.

■ Nasal endoscopic observation of pus, polyps or other disease can help confirm a diagnosis of CRS.

■ For areas that cannot be observed with nasal endoscopy, CT can be useful in helping to diagnose disease.

■ The use of combining symptoms, findings on nasal endoscopy, and the findings on CT scans can reliably and accurately diagnose and treat CRS.

■ Newer instruments and powered tools are now available making mucosal preservation possible.

■ Areas in the healing sinus cavity that demonstrate polypoid mucosa are most likely the areas that will demonstrate persistent inflammation. This is likely due to an osteitis reaction.

■ Aggressive postoperative debridement of devitalized bone in these areas will result in improved epithelialization of the sinus cavity. Simultaneously, equally aggressive management of infection and inflammation is needed.

■ Long-term antibiotics and long-term application of topical steroids are appropriate for the management of these conditions.

■ Literature is accumulating in support of the use of topical steroids, which are given preoperatively as well as postoperatively.

■ Details of endoscopic sinus surgery are provided elsewhere in this textbook.

■ It has been found that a definite relationship exists among allergy, bronchial asthma, and RS.

■ The allergic component must be treated appropriately if the management of RS is to be successful.

■ Similarly, successful sinus surgery results in a better ability to control bronchial asthma.