Download - Sinusitis Dan Polip Nasal
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SINUSITIS
Bestari Jaka BudimanBag THT FK Unand/ RS. Dr. M. Djamil
Padang
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Content
• Anatomi endoskopik• Patofisiologi• Gejala dan Diagnosis• Komplikasi• Penatalaksanaan
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Anatomi Endoskopik
Kunci penting Sinusitis K O M- Daerah sempit menuju sinus
maksila dan frontal- Ventilasi & Drainase ke 2 sinus- Variasi anatomis -> KOM sempit
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K O M
• Rongga antara konka media dan lamina papiracea
• Prosesus unsinatus• Infundibulum• Sel agger nasi• Resesus frontal• Bulla etmoid
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Sistem mukosiliar
• Dilapisi mukosa dg epitel torak berlapis semu bersilia
• Sel goblet &kelenjar seromukosapalut lendir• Silia dan palut lendir proteksiJalur transpor mukosiliar anterior dan posterior
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Patofisiologi Sinusitis
Sumbatan ostium sinus Ggn drainase & Ventilasi sinus
Silia kurang aktifLendir Mengental(media yg baik bakteri patogen)
Hipoksia Bakteri Anaerob
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Faktor Predisposisi/Etiologi Sinusitis
1. Obstruksi mekanik ostium sinus- Deviasi septum- Hipertrofi konka- BA- Tumor
2. Rinitis akut/kronis3. Rinitis Alergi
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Sinusitis….
5. Infeksi gigi rahang atas (sinus maksila)6. Trauma sinus Perdarahan Infeksi7. Barotrauma Nekrosis mukosa
Polusi udaraUdara dingin/kering
Perubahan mukosa
Silia rusak
4.
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Klasifikasi Sinusitis• Konsensus internasional 1993• Sinusitis Akut :
- Lama penyakit < 8 minggu- jumlah episode serangan akut < 4x pertahun- Reversibilitas mukosa sesudah terapi normal
• Sinusitis Kronis :- Lama penyakit >8 minngu.- Jumlah episode serangan akut > 4 kali pertahun- Perubahan mukosa irreversible : - Jar.granulasi
- Polipoid
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Sinusitis Akut
Diagnosis :1. Rinore purulen > 7 hari di ikuti :– Sumbatan hidung– Nyeri pada muka– Sakit kepala, demam, batuk– PND (+)– Nyeri gigi, nyeri telinga
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Diagnosis sinusitis akut
• 2. Rinoskopi anterior dan posterior sekret purulen di meatus medius dan adanya PND
• Pemeriksaan penunjang rontgen bila:- Sinusitis akut dengan gejala hebat- Tak ada perbaikan setelah terapi- Evaluasi terapi- Alasan medikolegal
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Pemeriksaan penunjang
• CT scan curiga komplikasi orbita
• MRI curiga komplikasi intra kranial
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Sinusitis Akut….• Nyeri :
Sinusitis Maksila : - bawah kelopak mata - Alveolus - gigi
Sinusitis etmoid : - Pangkal hidung - Kantus medius - Bola mata
Sinusitis Frontal : - Dahi Sinusitis Spenoid : - Verteks
- Oksipital - Belakang bola mata - Mastoid
pipi
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Pemeriksaan Penunjang
• Transiluminasi : suram/gelap
• Radiologik : - Waters
- Perselubungan
- Penebalan- Air fluid level
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Sinusitis Akut…..Mikrobiologik :
Pneumokokus Streptokokus Stafilokokus Hemofilus Influenza Virus Jamur
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Terapi Sinusitis Akut
• Konservatif :- AB 10-14 hari- Dekongestan- Mukolitik
Operasi <<< Jika ada : - Komplikasi
- Nyeri hebat karena sumbatan
sekret
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Sinusitis Kronis
Etiologi :
Silia Rusak
Gangguan drainase Perubahan Mukosa
Infeksi Kronis
Polusi Bahan Kimia
Obstruksi Mekanik
Alergi & Defisiensi Imunologik
Pengobatan infeksi akut tidak adekuat
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Diagnosis sinusitis kronis
1. Keluhan > 8 minggu dari satu atau beberapa keluhan :
• Sumbatan hidung• Rinore purulen• PND (+), batuk• Sakit kepala (pagi),nyeri muka• Halitosis• Anosmia/ hiposmia
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Diagnosis
2. Rinoskopi anterior dan posterior dan naso endoskopi septum deviasi, penyempitan kom, polip
3. Pemeriksaan Ro penebalan >50 %4. CT scan menilai kom5. Sinuskopi diagnosis sinus maksilla
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Polip dan konka bulosa
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Sinusitis
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Mikrobiologik
• Aerob : S. Aureus S. Viridans H. Influenzae
• Anaerob Peptostreptokokus Fusobakterium
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Penatalaksanaan1. Konservatif
AB Dekongestan Mukolitik Kortikosteroid topikal, dapat di tambah dgn:
- Diatermi : Memperbaiki Vaskularisasi- Pencucian Proetz : S. Frontal, etmoid, spenoid
- Pungsi & Irigasi : S. Maksila
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Penatalaksanaan
2. Operatif Sinusitis Maksila : Caldwell-luc Sinusitis Etmoid : Etmoidektomi :- Intra nasal
- Ekstra nasal Sinusitis Frontal : - Intra nasal
- Ekstra nasal Sinusitis Sfenoid : Intra nasal
FESS (Functional Endoscopy Sinus Surgery)= BSEF (Bedah Sinus Endoskopi Fungsional) Membersihkan Kompleks Osteo meatal
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Komplikasi Sinusitis• Tenggorok : Faringitis, laringitis, tonsilitis• Telinga : Tuba oklusi • Paru : - Bronkitis
- Bronkiektasis - Asma bronkial
• Saluran cerna : GastroenteritisSino bronkitis
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Komplikasi….
• Mata : Melalui duktus nasolakrimalis Tromboflebitis Perkontinuitatum : - Edema palpebra
- Selulitis orbita- Abses subperiosteal-Trombosis sinus
kavernosus• Osteomielitis & Abses subperiosteal :
S. Frontal S. Maksila Fistula oro antral
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Abses orbita dan selulitis
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Komplikasi…..
• Intra Kranial : Meningitis Abses ekstra dural/subdural Abses otak Trombosis sinus kavernosus
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POLIP NASAL
• Kelainan mukosa hidung dan sinus paranasal
Berupa - massa lunak
- bulat atau lonjong - bertangkai
- putih ke abu abuan - permukaan licin
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POLIP NASAL
• Etiologi pasti blm diketahui, berhubungan dengan :
- peradangan kronik mukosa hidung
- gangguan keseimbangan vasomotor
- peningkatan cairan intersisial mukosa hidung Fenomena bernoulli
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Polip di orofaring
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POLIP NASAL
• Patogenesis- edema mukosa
- stroma terisi cairan interseluler- mukosa sembab- polipoid
- turun ke hidung bertangkai
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POLIP NASAL
• Mikroskopis- epitel sama dengan mukosa hidung- sub mukosa sembab- tdd limfosit, plasma, eosinofil, netrofil, makrofag dan sel goblet- pembuluh darah sedikit- tak ada serabut saraf
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POLIP NASAL
• Gambaran klinis- hidung tersumbat menetap- terasa massa di rongga hidung- sukar membuang ingus- gangguan penciuman- tanda tanda sinusitis - pada pemeriksaan terlihat polip
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Diagnosis banding
• Konka hipertropi• Tumor jinak hidung, spt kordoma, papilloma
inverted, neurofibroma.• Meningokel( pada anak)
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Polip>< papilloma
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POLIP NASAL
• Pemeriksaan penunjang- Rontgen- CT scan- Endoskopi lebih dini
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POLIP NASAL
• Anjuran biopsi bila
- unilateral pada usia lanjut- penampakan seperti ganas- pada rontgen ada erosi tulang
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POLIP NASAL
• Penatalaksanaan
- medikamentosa- operasi- kombinasi
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