Endoscopy of the maxillary sinus

The use of modern fiber-optic endoscopes allows to examine the maxillary sinus in vivo and to reveal signs of inflammation (mucosal hyperemia, its polyposis changes, etc.). Modern fiber-optic endoscopes are complex devices equipped with ultra-short focus optics with a wide viewing angle, a digital video converter, a television monitor, which allows for image analysis. In addition, the screen of the monitor can be considered not only a general picture of pathological changes, but also to detail the individual elements of the image, determining their pathological anatomy.

Ultrasound is carried out using an instrument called "Sinuskan." The method is based on the following properties of ultrasound:

1. Do not penetrate through the air environment (the US in gases is spreading with a large attenuation);
2. penetrate well through liquid and dense media;
3. reflect from the boundary of two contiguous media of different densities, for example, liquid / bone, bone / air, bone / cyst, and the like; therefore, when the ultrasound passes through heterogeneous layers of tissues from each interface, a partial reflection occurs and returns to the receiver combined with the acoustic probe; the mini-computer reads the time difference of arrival to the receiver of the reflected ultrasound and forms on the display screen spatially separated indicator strips whose distance from the "zero mark".

X-ray diagnostics makes it possible to establish the nature of the pathological process almost completely, since the X-ray patterns reveal those structures that perform the cavities of the paranasal sinuses. If there are inflammatory changes in the ONP, their transparency is violated.

When radiographing in the standing position (vertical position of the head), the fluid contained in the sinus flows down, and then on the roentgenogram its level is visualized as an arc. Sometimes on the roentgenogram the pillow-shaped limited edemas of the mucous membrane are revealed, which are visualized in the form of gentle rounded shadows.

A very promising and inexpensive method of X-ray examination of the paranasal sinuses is the method of using water-soluble contrasting drugs of reduced concentration, which has a number of advantages over conventional sinus contrasting with the help of iodolipol: a decrease in the expenditure of the contrast drug, an improvement in the quality of diagnosis, and a decrease in the degree of masking of the volume formations located in the lumen of the sinus. To do this, the authors used a 60% solution of verohraphine or iodamide-300 of reduced concentration. Standard preparations were diluted with distilled water in a ratio of 1: 1, at which the maximum contrast effect was achieved.

Computer and magnetic resonance imaging of the maxillary sinus is used when there is a suspicion of the presence of gross organic lesions of the facial skeleton due to highly virulent infection in immunodeficiency states of the organism, as well as in severe clinical course of the inflammatory process, accompanied by signs of purulent complications (facial phlegmon, orbit and retro-mandibular area , abscesses of the frontal lobe and lesions of venous sinuses of the brain, etc.). As for the CT of the maxillary sinus in acute inflammation, there are not many such works. S.V. Kuznetsov et al. (1990) examined with the help of CT scans 84 patients with acute rhinosinusitis. In the maxillary sinus, influenza aetiology reveals an increase in the volume of the mucosa of the inner lining due to its edema and infiltration, while also visualized thickened internal structures of the nose, whose density is lowered and fluctuated within (10.6 ± 4.8) units. X (normally soft tissues in the paranasal sinuses are not visualized at all in CT). In bacterial rhinosinusitis, the soft tissue membrane in the affected sinuses also increases, but to a lesser extent than in the influenza sinusitis. Its density is 28-32 units. X. In the lumen of the maxillary sinus, there is almost always a certain amount of exudate with a density of 22 to 31 units. X. As the authors note, with bacterial inflammation, the informativity of CT does not exceed that of traditional x-ray methods, and for differential diagnosis of the nature of pathological changes, one also has to resort to traditional radiography. Therefore, as the authors note, with sufficiently clear roentgenological signs confirming the clinical picture of acute inflammation, it is inadvisable to resort to CT.

[1], [2], [3], [4], [5], [6], [7],