Pediatric Sinonasal Disease

Question 1

• between the inner and outer tables of the fontal bone
• dectectable in children by 7 years of age
• right and left rarely equal in size

Answer 1

Frontal sinus

Question 2

• small invaginations of the mucous membrane of the middle and superior nasal meatus into the ethomoid bone
• between the nasal cavity and the orbit
• present at birth

Answer 2

ethmoid sinuses

Question 3

• unevenly divided by a bony septum
• thin plates of bone separate sinus from optic nerves and chiasm, pituitary gland, internal carotid and the cavernous sinus
• derived from a posterior ethmoid cell that invades the sphenoid at 2 years olf

Answer 3

sphenoid sinuses

Question 4

• largest of th sinuses and occupies the bodies of the maxilla
• present at birth
• drain into the middle meatus via maxillary ostia
• apex extends towards zygomatic bone
• base form inferolateral wall of nasal cavity
• roof is floor of orbit
• floor is formed by alveolar part of maxilla

Answer 4

maxillary sinuses

Question 5

• signs/sx: nasal congestion, discharge, facial pain, postnasal drip
• viral is most common but may have bacterial superinfection
• anatomic obstruction vs mucosal disease (CF, immune dysfunction)

Answer 5

sinusitis

Question 6

• symptoms for <1 month
• pathogenesis: Viral (most common), bacterial (s.pneumonia, H. influenza, B. catarrahlis, S. aureus, s. pyogenes) fungal (aspergillosis)
• antibiotics for sever onset or worsening course
• if there is worsening or failure to improve after 72 hours of therapy then therapy may be changed

Answer 6

acute sinusitis

Question 7

Defined as: >3 months of 2 or more symptoms of pururlent rhinorrhea, nasal obstruction, facial pressure/pain or cough and either endoscopic evidence of mucosal edema, pururlent drainage or nasal polyps and or/ CT scan showing osteomeatal complex or sinus edema

Answer 7

Chronic Rhinosinusitis

Question 8

what are some etiologies of chronic rhinosinusitis? environmental contributions? obstructions?

Answer 8

• Etiology: Adenoiditis, allergic rhinitis, cystic fibrosis, asthma, GERD, primary ciliary dsykinesia
• Environment: smoke exposure, pollution, daycare
• obstruction: osteomeatal complex, stasis of secretion, inhibition of ciliary function, edema of ostia

Question 9

what are some orbital complications of sinusitis?

Answer 9

• preseptal cellulitis
• orbital cellulitis
• subperiosteal abscess
• orbital abscess
• cavernous sinus thrombosis

Question 10

what are intracranial complications of sinusitis?

Answer 10

• epidural abscess
• subdural abscess
• brain abscess
• meningitis (most common intracranial complication- highest risk -sphenoid sinusitis)
• pott’s puffy tumor- subperiosteal abscess of frontal bone that may have intracranial extension

Question 11

when would you use certain imaging for treatment of pediatric sinusitis?

Answer 11

• plain films of sinuses- screening, evaulates presence of air fluid levels, opacification
• lateral neck film- assess adenoid hypertrophy
• CT sinus- allows evaluation of sinuses and navigation during surgical procedures (radiation is a concern)
• MRI- good soft tissue, poor bone detail, indicated for complications of sinusitis, masses