Pathophysiologic Basis of Chronic Sinusitis

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Pathophysiologic Basis of Chronic Sinusitis

• Reda Kamel, M.D.
• Professor of Rhinology
• Cairo - Egypt

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Functional Endoscopic Sinus Surgery

• Anatomical Basis
• Patho-physiologic Basis
• Diagnostic Endoscopy
• Computed Tomography
• Selection of Patients Procedure
• Functional Endopscopic Surgery
• Complications
• Reda Kamel

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Healthy Sinus

• Aeration Drainage
• Ostium
• Patent
• wide
• Mucous Membrane
• Mucous (Amount Thickness)
• MCC

Reda Kamel
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MCC of the Maxillary SinusTowards the Natural
Ostium
Reda Kamel
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Bypass of Accessory Ostium or Antrostomy
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Bypass of Accessory Ostium or Antrostomy
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MCC of the Maxillary SinusRecirculation
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MCC of the Frontal Sinus

• Medial wall Roof Lateral wall
• Floor Ostium.
• Divides at ostium
• Leaves along lateral edge of ostium Avoided in
  sinusotomy
• Enters sinus along medial edge of ostium
  Rhinogenic infection

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MCC of the Frontal SinusTowards the Natural
Ostium
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Pathophysiologic Basis of Chronic Sinusitis

• Physiology MCC
• Pathology Ostiomeatal complex blockage
• Treatment
• 1- Aeration
• 2- Drainage
• Reda Kamel

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Pathophysiologic Basis of Chronic Sinusitis

• Ostiomeatal complex blockage
• Anatomical variations
• Pathological abnormalities
• Reda Kamel

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Anatomical Variations

• Concha bullosa
• Paradoxically bent middle turbinate
• Medially bent uncinate process
• Large bulla ethmoidalis
• Reda Kamel

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Concha bullosa
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Pathophysiologic Basis of Chronic Sinusitis

• Pathological abnormalities
• Swollen edematous ager nasi
• Swollen edematous uncinate process
• Polypoid anterior end of middle turbinate
• Edema of infundibular wall prolapsed
• Reda Kamel

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Pathophysiologic Basis of Chronic Sinusitis

• Pathological abnormalities
• Pus from the middle meatus
• Polyps from the middle meatus
• Swollen edematous bulla ethmoidalis
• Reda Kamel

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Chronic SinusitisConventional Surgery

• Inferior Meatal Antrostomy
• IMA
• Gravity - dependent drainage
• Conservative surgery
• Reda Kamel

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Chronic SinusitisConventional Surgery

• Radical Antrum operation
• RA
• Irreversible pathology
• Radical surgery
• Reda Kamel

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Inferior Meatal Antrostomy IMA
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Inferior Meatal Antrostomy IMA
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Chronic SinusitisEndoscopic Surgery

• Functional Endoscopic Sinus Surgery
• FESS
• Key zone OMC
• All the sinuses as one unit
• Reversible pathology
• Reda Kamel

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Pathophysiologic Basis of Chronic Sinusitis

• Physiology MCC
• Pathology Ostiomeatal complex blockage
• Treatment
• 1- Aeration
• 2- Drainage
• Reda Kamel

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Normal Aeration and DrainageAir in and
Secretions out
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Disease Blocked - OMC Mal-aeration and
Mal-drainage
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Operation FESS Restoration of Aeration and
Drainage
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Operation FESS Recovery of diseased
mucosa
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Natural Drainage of the Paranasal Sinuses
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Abnormal Drainage of the Paranasal Sinuses
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