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Chronic frontal sinusitis: treatment
Last reviewed: 23.04.2024
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The goals of chronic frontitis treatment
Restoration of drainage and aeration of the affected sinus, removal of pathological separable from its lumen, stimulation of reparative processes.
Non-pharmacological treatment of chronic frontal sinusitis
Electrophoresis with procaine or phonophoresis with hydrocortisone in combination with oxytetracycline on the front wall of the inflamed frontal sinus.
Drug treatment for chronic frontitis
Before receiving the results of the microbiological examination of the detachable, amoxicillin + clavulanic acid is prescribed, followed by antibiotics of directed action. If the discharge from the sinus is absent or can not be obtained, the treatment for chronic frontalitis that was started earlier is continued. The drug of choice in complex anti-inflammatory therapy can be used fenspiride. Assign vasoconstrictive drops in the nose (decongestaplast), at the beginning of treatment - mild vasoconstrictive action (a solution of ephedrine, dimethindene and combination with phenylephrine). In the absence of secretions, it is recommended to perform anti-edema therapy (furosemide, intravenous injection of 200 ml of 1% calcium chloride solution), use of antihistamines.
Anemization of the mucous membrane of the anterior part of the middle nasal passage is carried out with the help of vasoconstrictive drugs (solutions of epinephrine, oxymetazoline), naphazoline, xylometazoline, etc.).
The nasal shower (rinsing) of the nasal cavity is a procedure that does not change the pressure in the nasal cavity. The position of the patient sitting, with a tilted head in such a way that the ear is in contact with the shoulder. For washing, use 100-200 ml of 0.9% sodium chloride solution, heated to 35-36 ° C, with lactoglobulin dissolved in it against opportunistic bacteria and Salmonella or a directional antibiotic. The olive is injected into the overlying nostril, the solution is poured through a blood transfusion system at a frequency of 30-40 drops per minute. After passing through the nasal cavity and nasopharynx fluid is released from the opposite half of the nose.
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Surgical treatment of chronic frontitis
Probing of the frontal sinus through the frontal-nasal canal is performed with a metal probe of Landsberg or similar special probes after anemia and anesthesia of the anterior part of the middle nasal passage. It should be remembered that with this procedure, a very thin and inclined mucous membrane of the frontoclyphal canal is often damaged.
Frontal sinus puncture through the lower wall (usually in cases of medium and small sinuses) is performed using a blood transfusion needle or a device for sternal puncture.
Trepanopuncture is performed with the help of special devices for trepanation. In the front (front) wall of the sinus, an opening is inserted, through which a cannula is inserted into its lumen for rinsing. It is desirable to use devices by which the intervention is carried out simultaneously, that is, the contents of the sinus are isolated from the soft tissues of the frontal region during or after the administration of the cannula. Daily, the sinus is washed and, at the end, a mixture is added containing a directional antibiotic and a hydrocortisone suspension. Infusion of drugs is carried out in a horizontal position of the patient on the back with a slightly tilted head for at least 20 minutes.
Endonasal opening of the frontal pocket and expansion of the frontal-nasal canal are carried out with the help of hard endoscopes Hopkins or Karl Storz with optics of 0 and 30 degrees. Often, before the indicated intervention, it becomes necessary to resect the upper part of the hook-shaped process.
The extranasal opening of the frontal sinus is preferably carried out through the front wall and all of the autologous contents are removed. With a bilateral process, it is recommended to destroy the interstitial septum. Fronno-nasal fistula is formed by removing a part of the cells of the anterior group of the sinus. A significant expansion of the lumen of the frontal-nasal canal requires the introduction of a stationary drainage tube for 28-35 days for the epithelization of the formed anastomosis. Neither the 8-10th days for the patient's convenience the tube can be cut at the level of the middle nasal conch.
In a number of cases, the enlargement of the frontal-nasal canal is possible due to resection of a part of its anterior group of cells: if the subsequent conduct of the sample with the dye is positive, artificial fistula can not be imposed. Intervention is completed by prosthetics of the postoperative defect of the anterior wall of the frontal sinus.
Further command
Use of soft-acting vasoconstrictors for 4-5 days, gentle care of the wound. Approximate terms of incapacity for exacerbation of chronic gonorrhea without signs of complications in the case of conservative treatment and the use of sensing or trepanopuncture, as well as with extra-nasal interference are 6-12 days.
Information for Patient
- Beware of drafts.
- At the first signs of SARS, contact a specialist.
- Treatment of acute frontitis should be carried out until complete recovery, with the recommendation of the attending physician to perform a surgical correction of the nasal cavity.
Forecast
Favorable in observance of the rules of sparing regimen.
Prophylaxis of chronic frontitis
Prevention is the preservation of free nasal breathing and normal anatomy of the nasal cavity structures, especially of the ostiomeatal complex, as well as complete cure of acute acute rhinitis, acute respiratory viral infection, influenza, acute frontalitis. To prevent the development of the disease, surgical sanation of the structures of the altered nasal cavity is necessary in order to restore normal nasal breathing.