ACUTE MAXILLARY SINISITIS

The Maxillary sinus is most frequently infected

paranasal sinus. This may be due to its close proximity to teeth
& due to inadequate drainage because of higher level of the
ostium.
 AETIOLOGY:
I. Age: It usually occurs after the age of 15yrs, but it may affect
even children aged 5yrs.
II. Sex: It affects both the sexes equally.
III. Predisposing Factors:
1. Nasal Infection – The most common nasal infections are
the common cold & influenza. The infection reaches the
maxillary sinus from the nose in appoximately 90% of cases,
and following factors may help the spread of the infection
from nose:
 a) Nasal obstruction: Deviated nasal septum,
hypertrophic turbinates, polyp and new growths obstruct the
drainage of the sinus, resulting in stagnation of secretions in
sinus, and infection follows.
b) Nasal allergy may lead to blocking of the nose and
obstruction to the drainage of the sinus.
c) Habit: Forcible blowing of the nose pushes the
infection from the nose into the sinuses. The correct way of
blowing the nose is to blow through one nostril at a time after
blocking the other one.
d) Swimming: When water enters the nose forcibly,
particularly while diving, infection may spread to the sinuses.
e) Barotrauma may causes acute sinusitis in the same way
as it causes acute otitis media. This is likely to occur when the
patient flies during an attack of rhinitis.
2. Dental infection: Infection of the upper molars and premolars
may lead to maxillary sinusitis in approximately 8% of cases.
3. Trauma to the sinus results in collection of the blood in its
cavity and it may become secondarily infected.
4. Blood –borne infection is a rare possibility.
5. Neighbouring infection like chronic tonsillitis & adenoids may
act as predisposing factor.
6. Lowered resistance may result in the spread of infection to
the sinus easily. This may happen with influenza, measles or
chicken pox. Diabetes should be kept in mind for recurrent
infections.
7. Chill & exposure lower the resistance.
8. Atmospheric pollutions promotes nasal infections.
 PATHOLOGY:
1. Catarrhal Stage: Initially there is congestion & oedema of
the mucosa of the sinus & the ostium. There is hypertrophy
of the mucous glands.
2. Exudation Stage: Due to increased glandular activity,
secretions collect in the sinuses, which are mucoid initially.
3. Purulent Stage: The infection may progress to purulent
stage, and there is thick mucopurulent discharge, which
drains out through the ostium. Sometimes ostium may
becomes blocked due to mucosal oedema & secretions
become pent up in the sinus producing acute empyema of
the sinus.
4. Stage of Complications
5. Stage of Resolution: The infection may resolve at any stage
depending on the virulence of the organisms, resistance
offered by body and antibiotics administered.
 CAUSATIVE ORGANISMS:
1. Viral infection may be responsible.
2. Bacteria: Usually the infection is caused by the respiratory
tract organisms like streptococci, pnemococci, micrococcus
catarhalis, staphylococcus or haemophilus influenza.
However, gram negative bacilli like Bacillus pyocyaneus,
Bacillus coli, if the infection spreads from an infected tooth.

 SYMPTOMS:
1. Initially, a discomfort in the nasopharyngeal region may be
present.
2. Pain in the maxillary region is the presenting symptoms and
it may radiate to the teeth, eyes, frontal sinus and the ear. It
is aggravated on bending down, coughing and sneezing.
3. Nasal discharge is mucoid initially. It soon becomes purulent.
Sometimes it may be blood-stained. Foul smelling discharge is
suggestive of dental origin.

4. Blocking of the nose on the affected side occurs due to

congestion and oedema of the nasal mucosa.

5. Nasal resonance may change due to blocking of the nose.

6. Dry cough may be present due to postnasal discharge, which

trickles into oropharynx.

7. Epistaxis may be occasionally present due to congestion.

8. Constitutional symptoms: The patient may have malaise,

headache and fever.
 EXAMINATION:
1. Inspection: Slight oedema of the affected area.
2. Palpation: Maxillary sinus becomes tender.
3. Anterior rhinoscopy: There is congestion of the nasal
mucosa and turbinates, particularly the middle turbinates.
Discharge may be trickle down from the middle meatus.
4. Posterior rhinoscopy may reveal purulent discharge
trickling down through the choana.
5. Posture test to differentiate between maxillary & frontal
sinusitis. This test is hardly being used as it is not reliable
and time consuming.
6. Transillumination test: This test is rarely being performed,
as it is clumsy and unreliable.
 INVESTIGATION:

1. Radiograph of the paranasal sinuses( Water’s view) show

haziness initially due to mucosal oedema. Later due to
collection of exudate , the entire sinus becomes opaque.

2. Bacteriological test: The nasal secretion may be sent for

smear, culture & antibiotic sensitivity.

3. Endoscopy of the nose and paranasal sinuses may be

performed.
 DIFFERENTIAL DIAGNOSIS:
1. Alveolar abscess

2. Cellulitis of the cheek

3. Furuncle

4. Insect bite

5. Angioneurotic oedema

6. Infra-orbital or Trigerminal neuralgia

7. Malignancy of maxillary sinus

8. Temporal arteritis
 COMPLICATIONS:

The complications may have become uncommon because

of antibiotics.
1. Pansinusitis
2. Middle ear infection
3. Pharyngitis, Laryngitis & Tracheobronchitis
4. Opthalmic complications: Peri-orbital & orbital cellulitis or
abscess may follow acute maxillary sinusitis.
5. Osteomyelitis
6. Asthama
7. Mucocele or pyocele may occur.
8. Oro-antral fistula
 TREATMENT:
A) General Treatment –
1. Antibiotics
2. Decongestants
3. Analgesics
4. Antihistamines
5. Rest – essential
B) Local Treatment –
1. Nasal decongestants drops
2. Steam inhalation
3. Fomentation or short wave diathermy on the sinus is
soothing.
4. Antral puncture