Acute antritis (maxillary sinusitis)

Acute antritis is an acute inflammation of the predominantly mucous membrane and the submucosal layer of the maxillary sinus, sometimes extending to the periosteum and in rare cases, with a particularly virulent infection, to the bone tissue with transition to a chronic form.

Causes of the acute sinusitis

Indications that inflammatory processes can develop in the maxillary sinus are found in medieval medical manuscripts, in particular, in the works of N. Gaimor (1613-1685). Acute antritis often develops as a complication of acute rhinitis, influenza, measles, scarlet fever and other infectious diseases, as well as due to inflammatory diseases of the teeth (odontogenic sinusitis). Various microbial associations, such as activated saprophytes, and introduced pathogenic microbiota can act as etiological factors.

[1], [2], [3], [4], [5]

Pathogenesis

The pathogenesis of acute sinusitis is determined by the source of infection, which can be rhinogenic (in the vast majority of cases) and, as noted above, odontogenic, traumatic and hematogenous. Sometimes the primary inflammatory process develops in the cells of the latticed labyrinth, or in the frontal sinus, and secondarily spreads on the maxillary sinus. According to foreign statistics, in 50% of cases there is a combined acute inflammation of the maxillary sinus and the cells of the latticed bone.

Acute genyinic sinusitis are mainly divided into catarrhal (serous) and purulent. However, a number of foreign authors adhere to a different classification. They divide acute sinusitis into catarrhal non-exudative, catarrhal exudative, serous-purulent, allergic, necrotic with damage to bone tissue, etc. In catarrhal form, considerable hyperemia and swelling of the sinus mucosa are observed; around the vessels and glands is expressed round-cell infiltration. This leads to thickening of the mucous membrane, a significant exudate and a decrease in air space in the sinus. Violation of the ventilation function about the occurrence of a "vacuum" supplements exudate with transudate. In the purulent forms of acute maxillary sinusitis, the circular cell infiltration of the mucosa is more pronounced than in the catarrhal, and the phenomenon of edema is less. These two forms represent two stages of the same process. In infectious diseases (especially with measles, scarlet fever, typhoid fever), sometimes foci of necrosis occur in the walls of the sinuses. According to some authors, the bone wall in infectious diseases is affected by the hematogenous way primarily, and only then the inflammation spreads to the mucous membrane.

In diphtheritic sinusitis, a fibrinous effusion is formed in the sinus cavity, the mucous membrane is sharply hyperemic, in places hemorrhages are visible.

In early childhood, acute sinusitis is rare and occurs more often in the form of osteomyelitis of the upper jaw, which can be followed later by the formation of purulent fistula, as well as more or less extensive necrosis of the soft tissues of the face and bones of the facial skeleton.

[6], [7]

Symptoms of the acute sinusitis

Symptoms and clinical course of acute sinusitis are not very diverse. By origin, usually distinguished rinogenous, odontogenic, hematogenous and traumatic acute sinusitis.

The pathogenic pathway is observed in acute inflammatory processes in the upper respiratory tract, as well as in intranasal surgeries. The onset of acute sinusitis is characterized by the fact that against a background of an acute cold of any etiology the patient has a unilateral headache, a feeling of bursting and pressure in the corresponding half of the face and in the field of the dog fossa; pain irradiates along the course of the second branch of the trigeminal nerve, sometimes extends to the alveolar process and the frontal region of the corresponding half of the face and head. Simultaneously, there are general clinical symptoms (fever, chills, malaise, weakness, loss of appetite, etc.). With the appearance of copious discharge from the corresponding half of the nose, the general condition of the patient improves, the body temperature and pain syndrome decrease. However, after a while, clinical symptoms may increase, which coincides with the cessation of discharge from the nose, again accumulating for one reason or another in the maxillary sinus. Usually with acute sinusitis, the headache and feeling of bursting in the corresponding half of the face grow during the night and reach apogee by morning, and by the evening these pains subsided in connection with the emptying of the inflamed sinus. Pain syndrome in acute maxillary sinus is caused by two main factors - the pressure of exudate on the nerve endings and the resulting neuritis and intoxication of numerous sympathetic fibers. Therefore, the pain syndrome is differentiated into two components: a constant, depending on the toxic neuritis of sensitive nerve endings, and periodic, synchronized with the filling and emptying of the sinus.

Allocations at the beginning of the disease are serous (the stage of catarrhal inflammation), then they become mucous and mucopurulent, sometimes with an admixture of blood. Hemorrhagic discharge that occurs at the very onset of the inflammatory process is characteristic of influenza antritemia, at the same time, herpetic eruptions can appear on the eve of the nose and in the region of the upper lip, as well as along the branches of the trigeminal nerve. A characteristic sign of the onset of acute sinusitis, which complicated acute rhinitis, is the cessation of discharge from one side of the nose (on the healthy side) and the continued excretion from the other half of the nose. If an acute cold does not pass within 7-10 days, then one should think about the presence of acute sinusitis.

Objectively, there may be swelling, redness and local increase in skin temperature in the cheek and lower eyelid, soreness in the palpation of the anterior maxillary sinus wall, and in the percussion of the malar bone, in which the pain transfers to the area of the anterior wall and the brow, the exit points of the branches of the trigeminal nerve bone holes on the surface of the facial skeleton, respectively - foramen (incisura) supraorbital et infraorbitale, - paresthesia and local sensitization of the skin above the anterior wall of the maxillary th sinus.

With anterior rhinoscopy in the middle nasal passage, mucopurulent discharge (a symptom of a purulent band) is noted, usually flowing into the nasopharynx. Therefore, with posterior rhinoscopy and pharyngoscopy, mucopurulent discharge is seen in the area of the nasopharynx and on the posterior wall of the pharynx. In unclear cases, a sample is made with lubrication of the mucous membrane of the middle nasal passage along its entire length with adrenaline solution, and after a few minutes the head is inclined downwards and to the side, affected by the sinus upward. When there is pus in the pus, it is released through an extended course (a symptom of Zablotsky - Desyatovsky). When examining the nasal cavity, swelling and hyperemia of the nasal mucosa is determined in the region of the middle nasal passage, the middle and often the inferior nasal concha. With bilateral sinusitis, the sense of smell is broken. When involved in the process of the periosteum and bone walls, the soft tissue is pastose in the area of the anterior wall of the affected sinus and the edema of the lower eyelid due to compression of the veins that carry out the outflow of blood from the lower parts of the orbit. Sometimes this swelling reaches a considerable size, closing the eye and moving to the other half of the face.

The hematogenous path is typical when common severe infectious diseases (influenza, scarlet fever, typhus, etc.) occur, when the pathogen, circulating along with the blood, penetrates into this or that paranasal sinus and causes inflammation under appropriate local favorable conditions. Sometimes in the occurrence of acute sinusitis, both ways of infection can participate. With some outbreaks of influenza, there has been a sharp increase in the number of patients with acute sinusitis and other inflammatory diseases of the paranasal sinuses. Thus, during the pandemic of the flu of 1918-1920, which received the name "Spanish" in Russia, autopsies revealed characteristic pathological changes in the maxillary sinus in 70% of cases.

Odontogenic genyantritis most often develops in the presence of radical inflammatory processes and the proximity of the affected root of the tooth to the bottom of the maxillary sinus.

According to the clinical picture, odontogenic sinusitis differs little from the genyantritis of another etiology. As already noted, the disease is associated with the spread of pathogens from infected teeth, which is promoted by the above anatomical features. Usually the maxillary sinus is located above the holes of the 2nd premolar (5th tooth) and the 1st and 2nd molars (6th and 7th teeth). With large sinuses, it extends posteriorly to the third molar (8th tooth), and anterior to the 1st premolar (4th tooth) and less often to the canine (3rd tooth).

The roots of the teeth located in the alveolar process are separated from the bottom of the maxillary sinus by a bone septum of different thicknesses. In some cases it reaches 1 cm or more, in others it is sharply thinned and can consist only of the periosteum or only the mucous membrane of the sinus. According to LI Sverzhevsky (1904), the thickness of the lower wall of the maxillary sinus is directly dependent on the level of the location of its bottom relative to the bottom of the nasal cavity: in 42.8%, the bottom of the maxillary sinus is below the bottom of the nasal cavity, 39.3 % - at the same level as him and 17.9% - higher than him. Most often odontogenic sinusitis occurs in cases where granulating periodontitis or apical granuloma, destroying the septum between the bottom of the maxillary sinus and periodontium, involves the inflammatory process of the sinus mucosa. The spread of infection in odontogenic diseases is also possible through a system of venous plexus located between the tissues of the alveolar process and the mucous membrane of the maxillary sinus. Occurring with acute catarrhal sinusitis odontalgia (most often the pain is projected on the area of the 5th and 6th teeth) often simulate pulpitis or periodontitis, which can lead to erroneous dental diagnosis and unjustified interference on the teeth. In operative interventions on the maxillary sinus and when the high standing of the teeth is established, caution should be exercised in the mucosa of the bottom of the maxillary sinus, since with vigorous scraping, damage to the neurovascular bundle of the tooth pulp is possible, leading to necrosis and subsequent infection. Sometimes, with a very thin lower wall of the maxillary sinus and manipulations on the appropriate teeth (extraction, depulpation, etc.), perforation of the bottom of the maxillary sinus occurs to form a fistula. If in this case there is a complication in the form of acute sinusitis, then purulent discharge appears through this fistula. In such cases, appropriate sanation of the maxillary sinus and, if necessary, plastic closure of the fistula are necessary.

It is worth noting the odontalgia observed sometimes, especially with acute catarrh of the maxillary sinus, simulating the pains that occur during pulpitis or periodontitis. Patients are experiencing acute pain in the teeth, more often in the 2nd small and 1 large molar teeth of the upper jaw. Such complaints of patients often lead to an erroneous diagnosis and subsequent wrong and unsuccessful medical measures in the form of depulpation of teeth, removal of seals and even the tooth itself. The same pain in these teeth can occur in the early stage of cancer of the upper jaw. Removal of the loosened tooth results in a rapid growth of "granulations" (tumor tissue) from the tooth socket.

Traumatic sinusitis is an acute suppurative inflammation of the maxillary sinus, resulting from a blunt or gunshot injury to the upper jaw resulting from:

1. infection of the maxillary sinus hematoma;
2. fracture of the bones of the upper jaw with violation of the integrity of the walls of the maxillary sinus, the insertion of bone debris into it and its subsequent infection;
3. violation of the integrity of the upper jaw with a gunshot wound with penetration into the maxillary sinus of foreign bodies (bullets, fragments of mines and shells, secondary fragments).

The clinical picture of acute maxillary sinusitis in these injuries depends on the mechanism of the traumatic process, localization and degree of destruction of bone tissue and mucous membrane of the sinus, as well as on the nature of damage to adjacent anatomical formations (orbits and its contents, nasal cavity, vessels, nerves, etc.). The acute sinusitis associated with such traumas is combined with the clinical manifestations characteristic of injuries of neighboring organs, and the therapeutic measures are determined by the severity of the leading clinical syndrome.

The clinical course of acute maxillary sinusitis can evolve in several directions:

1. spontaneous convalescence is the usual completion in many catarrhal forms of acute maxillary sinusitis, which occurs simultaneously with the common cold that provoked this sinusitis; This is facilitated by good immunological resistance of the organism, weak virulence of the microbial factor, favorable anatomical features of the endonasal structures, effective functioning of the excretory ducts of the sinuses, etc .;
2. recovery resulting from the use of adequate treatment;
3. the transition of acute sinusitis to the chronic stage, which is promoted by the high virulence of the microbiota that caused the inflammatory process, weakened immunity, concomitant chronic diseases of the upper respiratory tract and bronchopulmonary system, a general allergy, an unfavorable structure of the anatomical elements of the nose and maxillary sinus (curvature of the nasal septum, narrow or blocked excretory ducts), etc .;
4. complications of acute sinusitis can occur due to the same causes that lead to chronic inflammation; Most often these complications arise from the hematogenous and lymphogenous path and concern primarily intracranial complications (meningitis, cerebral abscess, sinus troboz, sepsis, etc.); Of the local complications, phlegmon of the orbit, the retro-mandibular region, and the face are in first place.

[8], [9], [10], [11]

Treatment of the acute sinusitis

Treatment of acute sinusitis is usually carried out by non-surgical-medicamentous and physiotherapeutic means. Surgical interventions are resorted to in the occurrence of secondary purulent complications, when there is a need for a wide opening of the affected sinus with the elimination of foci of infection in surrounding tissues and organs, for example, in the rhinogenic phlegmon of the orbit.

The basic principles of nonoperative treatment of acute sinusitis are as follows:

1. restoration of drainage and ventilation functions of the opening connecting the maxillary sinus with the middle nasal passage;
2. application of methods of active removal from the sinus of pathological contents and the introduction of drugs into it;
3. use of general antibacterial, desensitizing (antihistamine) and symptomatic agents;
4. application of physiotherapy methods;
5. application of methods of increasing the immune resistance of the organism;
6. application (according to indications) of extracorporeal methods of body detoxification;
7. creating comfortable conditions for the patient and eliminating risk factors for the occurrence of complications and superinfection;
8. sanation of foci of infection, which can serve as a source of maintenance of the inflammatory process in the sinus, in those volumes that are acceptable for a given condition of the patient (for example, acute pulpitis, exacerbation of chronic periodontitis or tonsillitis, etc.).

Treatment of acute inflammatory diseases of the paranasal sinuses should be performed strictly under the supervision of an otorhinolaryngologist in comfortable home or (preferably) hospital conditions. This situation is dictated by the fact that in some cases these diseases can cause rapidly growing life-threatening complications that require timely diagnosis and radical measures, therefore "self-treatment" in acute inflammatory diseases of the paranasal sinuses is unacceptable, as is the unacceptable independent use of any widely advertised "universal" medicine without proper professional diagnosis of the clinical form of the disease. Treatment of inflammatory diseases of the paranasal sinuses should be comprehensive, and its results should be verified by special methods of examination of the patient.

Restoration of the drainage function of the outlet channel by instillations, applications and lubrication of the nasal mucosa and the middle nasal passage with appropriate vasoconstrictors is either ineffective or gives a temporary effect on the period of action of the applied agent. The ineffectiveness of this method is due to the fact that the said channel is usually blocked from within the swollen mucous membrane of the sinus, and also over its small length, which prevents access of the drug to its deep sections and to the area of the axillary orifice. These methods can be applied only at the preclinical stage of treatment. The most effective means of achieving this goal is the puncture of the maxillary sinus and the imposition of a special drainage catheter, which simultaneously serves for the spontaneous elimination of the pathological contents of the sinus, its aeration, washing with antiseptic solutions and the introduction of therapeutic solutions (proteolytic enzymes, antibiotics, steroid preparations, ). In some cases, the puncture of the maxillary sinus does not reach the "standard" goal due to the insuperable blockade of the outlet hole. In this case, the experienced doctor punctures the sinus with a second needle and thus forms a communicating "siphon" that allows one to inject the wash liquid through one needle, and through the second needle - to remove the pathological contents of the sinus along with the wash fluid. After this, a catheter is inserted, and both needles are removed.

The technique of draining the maxillary sinus with a catheter is as follows. After puncturing the sinus, you should make sure that the end of the needle is in the sinus cavity. This is achieved by the fact that when the piston is slightly pulled out, some amount of sinus contents appears in the syringe. If, when pulling the piston, there is a feeling of "vacuum" (blockade of the discharge hole), then 1-2 ml of air is introduced into the sinus, while if the needle is in the sinus cavity, when the air is injected, it enters the nasal cavity with a characteristic sound and a corresponding sensation patient. If both methods fail to reach the target, then the second needle is punctured with the second needle, keeping the first one, washing the sinus through one of the needles, injecting the appropriate drug solution and inserting the catheter into one of the needles, moving it a distance greater than the length of the needle, or until it stops in the back wall of the sinus and then stretching it to 0.5-0.7 cm. The catheter is introduced as follows. In the needle enter a tight thin plastic conductor and, holding it in the cavity of the sinus, remove the needle. Then, a special plastic catheter is inserted into the sinus in the sinus, the tip of which is sharply chamfered, and in the beginning there is a cone-shaped extension for inserting the cannula of the syringe into it. The most difficult moment in the introduction of a catheter into the sinus through the conductor is the passage of the bone wall. Next, remove the plastic conductor and carefully fix the catheter with adhesive plaster on the skin of the malar bone, which during conversation and chewing remains fixed, thus eliminating the risk of catheter displacement during movements of the lower jaw. The catheter is used as a drainage and for the introduction of medicinal solutions in the sinus (1-2 times a day) until the local and general clinical symptoms of acute sinusitis disappear completely, as well as to complete purification of the wash liquid. The fluids introduced into the paranasal sinuses should be heated to 38 ° C.

If, for one reason or another, the puncture of the maxillary sinus has failed or is contraindicated (hemophilia), then you can try to apply the "move" method to the Proetz. According to this method, after deep anemization of the nasal mucosa, especially in the middle nasal passage, an olive is inserted into the corresponding half of the nose, connected with a suction or syringe to rinse the cavities and, tightly pressing the wing of the nose of the opposite side, create a "negative" pressure in the nasal cavity and nasopharynx, as a result of which the contents of the sinuses are released into the nasal cavity through natural openings. In this case, the "own" negative pressure is created in the sinus, which sucks in them the drug substance introduced after the aspiration (proteolytic enzyme, antibiotic, etc.). This method is effective only if it is possible to establish at least for the duration of the procedure the patency of the axillary-nasal aperture.

In acute catarrhal sinusitis, effective treatment can be achieved without sinus puncture, but for this, a number of complex measures should be used that provide a comprehensive therapeutic effect on the pathological focus. For this, locally used composite vasoconstrictive and therapeutic ointments containing essential oils and extracts of medicinal plants, balsamic substances that have a beneficial effect on trophic processes in the mucous membrane of the nose and sinuses, steroid preparations that reduce the interstitial swelling of the nasal mucosa, and also some antiseptic solutions for washing the nasal cavity and its preparation for the introduction of the main remedy. The same solutions can also be used to wash the sinus. Experience shows that with catarrhal sinusitis, timely and successfully performed washing of the maxillary sinus even with sterile isotonic sodium chloride solution is a very effective remedy. As other solutions for irrigation of the nasal cavity and washing of the maxillary sinus, solutions of furacilin (1: 5000), rivanol (1: 500), potassium permanganate (0.1%), boric acid (4%), silver nitrate (0.01 %), formalin (1: 1000), soluble streptocid 2 (5%), antibiotic solutions of levomycetin (0.25%), biomycin (0.5%), etc. Corresponding to this pathogenic microbiota. In most cases with uncomplicated acute maxillary sinusitis, on the 2nd-3rd day, the severity of general and local signs of the disease is reduced and usually recovery occurs on the 7th-10th day. However, in the next 2-3 weeks, a certain regimen should be observed (stay in a warm room, do not cool, do not consume cold drinks, do not stay in a draft, do not engage in heavy physical labor).

To prevent a microbial allergic reaction, prescribe antihistamines (see the treatment of an allergic rhinitis), ascorbic acid, calcium gluconate, antibiotics (with a general pronounced body reaction), as well as analgesics and sedatives; from physiotherapy - dry heat (sollyks), UHF, laser therapy, etc.

If the puncture of the maxillary sinus is not always indicated in catarrh of the maxillary sinus, especially with an obviously positive dynamics resulting from the use of nonoperative treatment, in serous sinusitis characterized by accumulation in the sinus of a large amount of serous fluid, whose viscosity prevents its independent release from the sinus through a natural aperture, puncture is necessary not only to evacuate the contents of the sinus and alleviate the condition of the patient, but also as a warning of suppurative exudate. For this, the methods described above (double puncture, the introduction of a catheter, the washing of the sinus with antiseptic solutions, and the introduction of a broad spectrum of antibiotics into the sinus, including those directed against anaerobes) are used for this.

For the treatment of patients with exudative sinusitis VDDragomiretsky et al. (1987) proposed a combined method involving intracavitary laser irradiation with a monofilament quartz fiber with simultaneous sinus oxygenation. The method gave a positive effect to more than half of those who received this treatment.

With edematous forms of acute maxillary sinusitis occurring against the background of influenza infection, which occur with a high body temperature and excruciating pain, irradiating along the branches of the trigeminal nerve, with the manifestations of general intoxication, the introduction of glucocorticoids into the sinus in a mixture with the corresponding antibiotic is shown, which significantly enhances the antibacterial action the latter and reduces the swelling of the sinus mucosa. With edematous forms of acute sinusitis and acute inflammatory diseases of the paranasal sinuses, it is recommended to use drugs that have vasoconstrictive, anticongestive and antihistamine action (fensipyride, pseudoephedrine, xylometazolium, oxymetazoline, miramistin and some others) at all stages of development of the pathological process. To combat infection, depending on the type of microbiota and its sensitivity to antibacterial agents, both locally and per os and parenterally different antibacterial agents (lincosamides, macrolides, azalides, penicillins, etc.) are used. Simultaneously, during a prolonged course of the inflammatory process, immunomodulators (ribomunil) are prescribed. The indications are also non-narcotic analgesics, including non-steroidal and other anti-inflammatory drugs (diclofenac, Rapent Rapid, etc.). At a virus etiology of an acute genyantritis apply antiviral agents at an obligatory combination with antimicrobial preparations.

Antiviral drugs are designed to treat various viral diseases (influenza, herpes, HIV infection, etc.). These drugs are used for prevention. Depending on the form of the disease and the properties of the drug, various antiviral agents are used per os, parenterally or topically (in the form of ointments, creams, drops). According to sources of receipt and chemical nature, antiviral drugs are divided into the following groups:

1. interferons (endogenous origin and obtained by genetic engineering, their derivatives and analogues);
2. synthetic compounds (amantadines, arbidol, ribavirinzidovudii, etc.);
3. substances of vegetable origin (alpazarin, flakozid, chelepin, etc.);
4. a large group of antiviral drugs are derived from nucleosides (acyclovir, stavudine, didanosine, ribavirin, zidovudine, etc.).

Derivatives of nucleosides (nucleotides) are designated as chemotherapeutic agents with a resorptive effect. The mechanism of their action is that all of them in cells infected with the virus are phosphorylated, converted into nucleotides, competing with "normal" (natural) nucleotides for insertion into viral DNA and stopping the replication of the virus. Interferons are called a group of endogenous low-molecular proteins that possess antiviral, immunomodulating and other biological properties, including antitumor activity. Widespread use for the treatment and prevention of influenza and other viral diseases have resandin, adapromine, metisazon, bonaffton, etc.

In acute serous or purulent maxillary sinus, the contents of the sinus often thickens and it can not be removed with the help of a normal rinse. In such cases, proteolytic enzymes are introduced into the sinus, which play an important role in maintaining the tissue homeostasis in inflammation in vivo in the "proteolytic enzyme-proteinase inhibitor" system. For treatment, proteolytic enzymes are used as a means for lysing thickened conglomerates of protein fractions for their transformation into a flowable substance and for free removal from the pathological cavity by washing. For this, chymotrypsin is used for crystalline, lidaz (hyaluronidase), lysozyme, which are available as powders in sterile ampoules, from which ex tempore appropriate solutions are prepared for sinus administration: 0.01 crystalline chymotrypsin is dissolved in 5 ml of sterile isotonic sodium chloride solution; 0.01 (64 units) of lidase is dissolved in 1 ml of sterile distilled water; lysozyme, released in bottles of 0.05 grams, is dissolved in 10 ml of sterile isotonic sodium chloride solution and injected into the sinus 5 ml.

Solutions of proteolytic enzymes are introduced into the pathological cavity after washing with an antiseptic solution, and then with distilled water. Then the sludge residues are removed from the sinus and the proteolytic enzyme solution is injected for 10-15 minutes. After that, the sinus is again washed with distilled water and an appropriate etiotropic preparation is administered, usually an antibiotic selected for this pathogenic microbiota. The procedure is performed daily until the sinus is cleared of pathological contents and the overall condition of the patient is improved.

In severe forms of acute inflammatory diseases of the paranasal sinuses, accompanied by septicemia, expressed by a general intoxication, detoxifying agents are administered in combination with symptomatic treatment aimed at normalizing the activity of the cardiovascular, respiratory and digestive systems, eliminating the pain syndrome and other disorders.

Detoxification is a complex of therapeutic measures taken to stop the exposure of toxic substances and their removal from the body. The achievement of this goal is served by a large number of methods aimed at stimulating natural detoxification, as well as artificial and antidote detoxification therapy. Methods aimed at enhancing physiological detoxification in relation to lesions of the ENT organs and in particular to inflammatory diseases of the paranasal sinuses include forced diuresis and regulation of enzyme activity (dimephosfon, potassium aspartate, sodium hydrogen carbonate, sodium chloride, sodium citrate, polyhydroxyethyl starch, electrolytes, ammonium chloride, acetazolamide, hydrochlorothiazide, etc.). Artificial detoxification is based on the use of processes of dilution, dialysis and sorption. The methods of its carrying out are asphyxiation (dilution and replacement of blood or lymph), dialysis and filtration (hemo-, plasmo- and lymphodialysis, ultra- and hemofiltration), sorption (haemo-, plasma- and lymphosorption) and physiohematological methods (UV and laser radiation , magnetic treatment of blood). The implementation of artificial detoxification methods involves the use of a large number of pharmacological agents related to blood and plasma substitutes (albumin, dextran, dextrose, copolyvidone, rheopolyglucin, etc.).

Surgical treatment for acute sinusitis is indicated only in complicated cases (osteitis, osteomyelitis, phlegmon orbit, soft facial tissues, retro-maskillary region, intracranial complications, sepsis). The purpose of surgical intervention is the elimination of pathological tissues and providing a broad drainage of the pathological cavity. It should be avoided deep curettage of the mucous membrane, so as not to cause the spread of infection through the intraosseous veins-emissaries, anastomosing with veins of the face, orbit and meninges. In the postoperative period, the wound is opened by a method with a continuous or frequent periodic irrigation with a solution of the corresponding antibiotic.

Forecast

The prognosis of acute maxillary sinusitis is generally favorable, even with the emergence of local and intracranial complications, except when the disease occurs against a background of a severely weakened organism, any common severe infection (eg, pulmonary tuberculosis, severe influenza, etc.). In these cases, when there is intracranial complications, the prognosis regarding life is very doubtful. With complicated forms of acute sinusitis and other paranasal sinuses, the prognosis is unfavorable in AIDS. According to many authors, a characteristic feature of acute inflammatory diseases of the paranasal sinuses that have arisen against HIV infection is the lack of any effective result from the traditional treatment. As a rule, EHFD in AIDS end in death.

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