1. headache 2. reflex neuralgia 3. olfactory impairment 4. dizziness 5. postnasal drip
Examination The traditional method of examination is to anesthetize the surface of the nasal cavity, the long rhinoscope will be inserted into the nasal cavity, and the middle turbinate is pushed open outward, and pus secretion can be seen at the mouth of pteroid sinus sometimes, and there is pus in olfactory fissure, and there is congestion of mucous membrane in pteridospermous sieve fossa, and the mucous membrane of the posterior pharyngeal wall is congested and thickened, and there is visible pus at the posterior nasal aperture. There is pus at the posterior nostril. However, due to poor illumination, it is not easy to observe.
Fiber-optic-guided nasal endoscopy, can be seen in the upper nasal passages and pteronasal sieve fossa mucosal edema, polypoid lesions, and pus secretion, pteronasal sinus mouth may be blocked by polyps, contraction of mucosal congestion and pus secretion can be seen. Because of the high visibility of this method, the lesion is not difficult to detect. The disease is generally divided into 2 categories, acute and chronic, and its causes are many and complex. Acute pteroid sinusitis is mostly caused by acute rhinitis; chronic pteroid sinusitis is often formed due to acute pteroid sinusitis failure to be completely cured or recurrent episodes. At present, it is believed that the pathogenesis of pteroid sinusitis is mainly due to various causes of sinus opening obstruction leading to infection in the pteroid sinus, in which nasal polyps are an important cause of pteroid sinus opening obstruction, and pteroid sinus inflammation stimulation in turn promotes the growth of nasal polyps. In addition, swimming sewage into the pterygoid sinus, the spread of infection in neighboring organs, nasal tumors impede the drainage of the pterygoid sinus, as well as trauma can cause pterygoid sinusitis.
Common sense
Inflammation of the mucosa of the pterygoid sinus. Of the various types of pterygoid sinusitis, maxillary sinusitis is the most common, followed by inflammation of the sieve sinus, frontal sinus and pterygoid sinus. Pterygoid sinusitis can occur singly or in multiple cases. The most common cause is nasal infection followed by purulent inflammation of the pterygoid sinuses. In addition, allergic reactions, mechanical obstruction and air pressure changes are easy to induce pterygoid sinusitis, dental infection can cause odontogenic maxillary sinusitis. Often manifested as nasal congestion, runny nose, sneezing, irritating cough, nasal itching, nasal dryness, nosebleed and so on.
Pathologic changes according to 58 cases of nasal endoscopy, single pterygoid sinusitis accounted for 34%, coexisting with the latter group of sieve sinusitis accounted for 14%, coexisting with the former group of sinusitis accounted for 19%, and total sinusitis accounted for 33%.
Treatment I. Conservative therapy Negative pressure replacement is still effective, can be in 1% ephedrine solution with appropriate amount of antibiotics, corticosteroids, enzymes and so on.
Chinese medicine therapy: Chinese medicine treatment is commonly used ginger butterfly sinus rhinitis, herbal formula: 30 grams of Cang Er Zi, 20 grams of Xin Yi, 35 grams of Scutellaria, 4 grams of fine Xin, 25 grams of Angelica dahurica, 10 grams of Gentian grass and other Chinese herbal medicines. Handmade process, careful selection, drying, grinding, external use, twice a day, has a definite effect on butterfly sinusitis.
II. Surgical therapy
1. Pterygoid sinus irrigation method For chronic pterygoid sinusitis, the effect of conservative treatment is not good, the examination found that the pterygoid sinus mouth has a blockage, the drainage is not smooth, and the symptoms are significant.
(1) Nasal mucosa is anesthetized with surface anesthesia with 1% dicaine (plus 0.1% epinephrine), and then a long rhinoscope is placed between the middle turbinate and the nasal septum to push the turbinate to the outside and widen the olfactory fissure.
(2) A catheter with a graduated, slightly curved anterior end was inserted obliquely upward through the olfactory fissure of the nasal cavity to arrive at the sieve plate, and moved backward from anterior to posterior to reach the anterior wall of the pterygoid sinus. The catheter can enter the opening of the pterygoid sinus when the catheter crosses the middle turbinate exactly in the center of the lower edge of the middle turbinate. Optional endoscopic guidance with a 30-degree view allows the catheter to be inserted into the opening of the pterygoid sinus under clear vision.
(3) The syringe is filled with sterile saline, and the catheter is connected to the catheter for suction, and after determining that there is pus, the patient is instructed to lower his head, hold the curved disk, and then rinse. Blind puncture and rinsing of the pterygoid sinus is dangerous and should not be used.
2. Enlargement of the opening of the pterygoid sinus is suitable for those who have difficulty in flushing the pterygoid sinus with the above method.
(1) Local anesthesia as above. The middle turbinate is pushed outward to expose the anterior wall of the pterygoid sinus, and the posterior portion of the middle turbinate is resected to enlarge the field of view if necessary.
(2) The sieve sinus hooked knife is inserted into the pterygoid sinus opening to break the bone wall on the outside of the opening, and then the rotary-head pterygoid sinus biting forceps are put in to widen the opening of the pterygoid sinus and take out the broken bone fragments, if it is recognized that there is really a polyp in the sinus can be taken out, but care should be taken to avoid damaging the outer wall of the pterygoid sinus and the upper wall in order to avoid the danger.
3. Chiseling of the anterior wall of the pterygoid sinus is indicated in chronic pterygoid sinusitis when the above treatments are ineffective or when there is complication of retrobulbar optic neuritis and intracranial infection. There are the following surgical approaches:
(1) Nasal septum approach The nasal septum is anesthetized with surface anesthesia bilaterally, and according to the septal submucosal resection, a mucosal incision is made on one side. Peel the mucoperiosteum to enlarge the range and reach the anterior wall of the pterygoid sinus. The septal cartilage is incised and the contralateral mucoperiosteum is peeled off to reach the anterior wall of the pterygoid sinus posteriorly and superiorly. The square cartilage of the nasal septum and the vertical plate of the sieve bone were resected to expose the rostral part of the pterygoid sinus, and the mucosa of the anterior wall of the pterygoid sinus was peeled off on both sides, so that the anterior wall was fully exposed. The anterior wall of the pterygoid sinus was removed with a bone chisel and bone biting forceps to access the pterygoid sinus to allow adequate opening and drainage. At the end of the procedure, the mucoperiosteum of the nasal septum was brought together bilaterally, the nasal passages were filled bilaterally, and the fillings were withdrawn the following day.
(2) Intranasal sieve sinus approach is suitable for chronic pterygoid sieve sinusitis. The method is the same as intranasal sieve sinus resection. After opening the anterior and posterior sieve sinus airspaces, the anterior wall of the pterygoid sinus can be found by continuing the exploration backward. The anterior wall of the pterygoid sinus can be divided into two parts, namely, the sieve room part (the outer part that is covered by the sieve room) and the nasal cavity part (the inner part that is exposed to the nasal cavity). The ratio of the area of the sieve chamber to the nasal cavity is about 5:3, and there is no difficulty in opening the anterior wall of the pterygoid sinus.
(3) Extranasal sieve sinus approach It is indicated in mycotic multiple sinusitis, which requires extensive exploration, as well as in suspected intracranial or intraorbital infections. It is not necessary for generalized solitary pterygoid sinusitis.
(4) Maxillary sinus approach For patients with chronic pterygoid sieve sinusitis in combination with chronic maxillary sinusitis (see De Lima procedure for chronic sieve sinusitis).
(5) Functional rhinoscopic sieve sinus approach This new technique has been developed in China, and the success rate of the procedure has been greatly improved because of the increased illumination and visibility compared with the traditional approach (see Surgical treatment of chronic sieve sinusitis).
There is no relationship between pterygoid sinusitis and the original head injury.