Acute Rhinosinusitis (ARS)

Acute Rhinosinusitis (ARS)

1. Viral Rhinosinusitis

   • Symptoms present for less than 10 days and not worsening.

2. Acute Bacterial Rhinosinusitis

   • Symptoms fail to improve within 10 days or worsen after initial improvement (double worsening).

3. Chronic Rhinosinusitis

   • Symptoms lasting 12 weeks or longer with inflammation documented by clinical findings.

4. Recurrent Acute Rhinosinusitis

   • Four or more episodes per year of ABRS without symptoms between episodes.

ZOSPE after 1 month, chronic or allergic most probably

Major: nasal discharge, obstruction, anosmia, facial pain minor: dental pain, hyposomnia, headache

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Functional Endoscopic Sinus Surgery (FESS)

Steps:

1. Medialize middle turbinate.
2. Excise uncinate process.
3. Anterior and posterior ethmoidectomies.
4. Sphenoidotomy.
5. Frontal recess dissection.
6. Create maxillary antrostomy.

Indications for Endoscopic Sinus Surgery

• Chronic sinusitis,
• Complicated sinusitis,
• Recurrent acute sinusitis,
• Failed medical management of acute sinusitis,
• Fungal sinusitis
• Obstructive nasal polyposis
• Sinus mucoceles
• Remove foreign bodies
• Tumor excision,
• Transsphenoidal hypophysectomy
• Orbital decompression,
• Dacryocystorhinotomy,
• Orbital nerve decompression,
• Grave’s ophthalmopathy
• Choanal atresia repair
• CSF leak repair
• Control epistaxis
• Septoplasty,
• Turbinectomy

Goals of FESS

• Complete removal of all disease.
• Permanent drainage and ventilation of affected sinuses.
• Postoperative access to previously diseased areas.
  

FESS Orbital Complications

• Blindness: Indirect injury (retrobulbar hematoma) or direct injury to the optic nerve.

• Orbital fat penetration: Increases risk of retrobulbar hematoma. Rx: recognize orbital fat (orbital fat floats); avoid further trauma; may complete the FESS; avoid tight nasal packing; Observe for vision changes, proptosis, or restricted ocular gaze

• Diplopia: Orbital muscle injury.
  orbital muscle injury, most commonly from medial rectus and superior oblique muscles

• Epiphora: Injury to lacrimal duct system.
  injury to lacrimal duct system, avoid operating anterior to the attachment of the uncinate; Rx: observation initially, if no resolution then dacryocystorhinostomy