Darkening of the ethmoid labyrinth of the nose. Ethmoiditis in adults and children

The paranasal sinuses are air cavities located around the nasal cavity and connected to it through narrow openings (Fig. 34).

They are named after the bones in which they are located.

All sinuses are paired, divided into anterior (maxillary, frontal, anterior and middle cells of the ethmoid bone) and posterior (sphenoid and posterior cells of the ethmoid bone).

Rice. 34. Frontal section through the nasal cavity and paranasal sinuses: 1 - frontal sinuses; 2 - cells of the ethmoid labyrinth; 3 - middle turbinate; 4 - inferior nasal concha; 5 - nasal septum; 6 - maxillary sinus

The medial wall borders the lower and middle nasal passages; the nasolacrimal duct passes through its anterior section. The sinus opening (ostium maxillare) is located under the orbital margin - the highest point of the sinus behind the protrusion of the nasolacrimal duct. Disruption of the function of this opening leads to the accumulation of secretions from the sinus, contributing to the development of an inflammatory process in it. The upper wall of the sinus is also the lower wall of the orbit. She is very thin. It contains the canal of the inferior orbital nerve and the vessels of the same name. Sometimes there are dehiscences covered only by the mucous membrane.

A thinned wall, along with defects in it, can contribute to the spread of the inflammatory process to the contents of the orbit, which requires caution during surgery. The lower wall is the alveolar process of the maxillary bone. In most cases, the bottom of the sinus lies below the bottom of the nasal cavity, which promotes close contact of the teeth with the sinus. The second premolar and the first molar are located closest to the bottom of the sinus. The posterior wall is represented by the maxillary tubercle, behind which are located the maxillary nerve, pterygopalatine ganglion, internal maxillary artery, and pterygopalatine venous plexus. The maxillary sinus is in close contact with the ethmoidal labyrinth, with which it shares a common wall.

The frontal sinus (sinus frontalis) is located in the scales and orbital region of the frontal bone. The following walls of the sinus are distinguished: anterior (facial); posterior (cerebral), bordering the anterior cranial fossa; lower (orbital), bordering the orbit and cells of the ethmoidal labyrinth; medial - intersinus septum. The anterior wall is the thickest. The thinnest is the orbital wall. The rear wall occupies a middle place relative to thickness.

The intersinus septum may be deviated in one direction or another. On the lower wall, on the border with the septum and closer to the posterior wall, there is an opening of the frontonasal canal. The dimensions of the frontal sinuses vary widely up to their complete absence on one or both sides. The anatomical proximity of the frontal sinuses to the contents of the anterior cranial fossa and orbit determines their pathogenetic relationship.

Ethmoidal cells (celhdae ethmoidales) are represented by air cells located between the frontal and sphenoid sinuses. The number, volume and placement of ethmoid cells vary significantly. On each side there are on average 8-12 of them. These cells are delimited externally by a paper plate (lamina papyracea), which approaches the lacrimal bone in front, the sphenoid sinus in the back, borders the frontal bone above and the maxillary and palatine bones below.

Based on their location, the ethmoid cells are divided into anterior and middle, which connect to the middle nasal meatus in the anterior section of the semilunar fissure (hiatus semilunaris), and posterior, which open into the upper nasal meatus. From the individual cells of the ethmoidal labyrinth it is necessary to distinguish: 1) the ethmoidal vesicle (bulla ethmoidalis) - behind, above the iolunate fissure, it laterally borders the paper plate, and medially, sometimes reaching significant sizes, it can push the middle concha towards the nasal septum; 2) frontal bladder (bulla frontalis) - protrudes into the hole frontal sinus; 3) fronto-orbital cells - located along the upper wall of the orbit; 4) bulla conchae - located in the anterior section of the middle turbinate.

It should be noted that the cribriform plate (lamina cribrosa) most often lies below the roof of the nasal cavity, therefore, when opening the cells of the ethmoidal labyrinth, it is necessary to strictly adhere to the lateral direction so as not to penetrate into the cranial cavity.

The sphenoid sinus (sinus sphenoidalis) is located in the body of the sphenoid bone. The partition divides it into two (usually unequal) parts. The opening (ostium sphenoidale) is located on its front wall, just under the roof of the nasal cavity.

The lower wall of the sinus forms part of the arch of the nasal throat, the upper wall is represented by the lower surface of the sella turcica, on which the pituitary gland is located. The lateral wall of the sinus is very thin, bordered by the internal carotid artery, cavernous sinus(sinus cavernosas), first branch trigeminal nerve, oculomotor, trochlear and abducens (III, IV, V and VI pairs of cranial nerves) nerves.

The mucous membrane of the paranasal sinuses is a continuation of the mucous membrane of the nasal cavity, but it is much thinner, instead of 5-6 layers of cells it has only 2. It is poor in blood vessels and glands and at the same time acts as periosteum. The movement of the cilia of the ciliated epithelium is directed towards the outlet openings of the sinuses.

Newborns have two sinuses: the maxillary and the ethmoidal labyrinth, represented by the rudiments. At the age of 6 years, the maxillary sinus takes on a normal shape, but its size remains small. By the age of 8, the bottom of the sinus descends to the level of the bottom of the nasal cavity, and by 12, below its bottom. By the time the child is born, the cells of the ethmoidal labyrinth are formed, but their number and size increase with age, especially in children from 3 to 5 years old. Frontal and sphenoid sinuses are absent in newborns; their formation begins by the age of 4 and ends at 16-20 years.

DI. Zabolotny, Yu.V. Mitin, S.B. Bezshapochny, Yu.V. Deeva

The expression is often used: the sinuses are airy, what is it?

During the process of breathing, the spaces that constitute the paranasal sinuses are filled with oxygen; they are air cavities.

In the sinuses it is cleansed, warmed and subsequently enters the human lungs.

The paranasal sinuses have an important feature in life. They are responsible for sneezing, that is, clearing the nose of harmful bacteria and allergens that enter the human body during breathing. They also influence a person’s sense of smell and create the timbre when speaking.

Having received the result, you can see the phrase in the diagnosis: “pneumatized paranasal sinuses.” If pneumatization is maintained, no pathological processes are detected; if it deviates from the norm, they are present.

There are three varieties:

1. Preserved pneumatization . This is the natural state of the paranasal sinuses, which allow oxygen to pass through. In this form, a person’s breathing remains normal, without deviations. The inflammatory process in the sinuses can only begin to develop, without causing discomfort or disruption of functional characteristics.
2. Reduced pneumatization . Changes occur in the progression of the inflammatory process, with the collection of mucous fluid and the presence of a foreign body in the paranasal sinuses.
3. Increased pneumatization . This is a rare pathological process. It occurs against the background of a violation endocrine system and pathological features of the facial bones. Increased pneumatization occurs in humans with gigantism.

Anatomical structure and location of the sinuses on the face

Humans have 4 pairs of paranasal sinuses:

1. Wedge-shaped
2. Frontal
3. The Highmorovs
4. Lattice

The sinuses have a surface in the form of a mucous membrane. There is practically no surface vascular network And nerve endings. Inflammatory process on early stage passes without any symptoms. On X-ray examination, the bones are clearly visible, the ethmoid labyrinth has a clear outline.

Main (sphenoid) sinus

Main (Sphenoidal) sinus

The main sinus is located in the body of the sphenoid bone, which is where it gets its name. Its peculiarity is that it does not have a pair. There is a wall inside it that divides the sinus in half. Each half has its own output channel, but they do not communicate with each other. They are unequal in size.

The sinuses consist of walls:

• The anterior one, which includes the ethmoid and nasal. They include the anastomosis, which helps keep the sinuses connected to the nose.
• The posterior one, which is too thin and may be subject to injury during surgery on the sphenoid cavity.
• The lower one, leading to the arch of the nasopharynx.
• The top one, which is bottom sella turcica
• Medial or internal.
• Lateral, located close to the carotid artery and ocular nerve endings.

Ethmoid sinuses (ethmoid labyrinth)

Ethmoidal sinus

The ethmoid sinuses are localized according to their anatomical structure between the sphenoid and frontal sinuses. It contains several cells, total which ranges from eight to ten on both sides. They are located in several tiers and communicate with each other and with the nasal cavity.

All components of the ethmoid labyrinth are divided into anterior, middle and posterior. Each person has their location individually.

Frontal (upper) sinuses

Frontal (frontal) sinuses

The frontal sinuses are located behind the eyebrows inside the frontal bone. They have front, back, inner and bottom walls. Front side considered the strongest. It contains the bridge of the nose below and the frontal tubercles above. If there is an inflammatory process in the frontal sinuses, the ENT doctor will hear a complaint from the patient when pressing in the area between the eyebrows.

The posterior side of the frontal sinus is located close to the cranial fossa. Below the wall is the base of the frontal sinus and top wall eyes. There is an anastomosis here, which, according to its anatomical structure, has the second name of the frontal-nasal canal.

Inside the sinuses there is a thin septum that divides them into two parts. The left and right halves are asymmetrical.

Maxillary (maxillary) sinuses

Maxillary (maxillary) sinuses

The maxillary sinuses are the largest cavities in anatomical structure. They are located above the thickness upper jaw, which is where their name comes from. Its base is taken from the outer wall of the nose. The shape resembles a triangle.

From below they border with the roots of the teeth of the upper row. ENT doctors warn that it is important to treat minor dental diseases, starting from banal caries, in order to prevent the transition of the inflammatory process to the maxillary sinuses. Neglect of this rule threatens a person with the development of odontogenic sinusitis.

From above they border with the lower part of the orbit and are its lower wall. With the inflammatory process of the maxillary sinus, vision impairment may occur.

In front, the maxillary sinus has the hardest and densest wall. An ENT doctor can palpate it when examining a patient. There is an anastomosis inside it that leads to the eyes. The maxillary sinuses are airy and their thrombosis can lead to inflammation.

Functions of the paranasal sinuses

The paranasal sinuses have functional characteristics for each person:

Sinus development in children

From birth until the age of twenty, the formation of the paranasal sinuses occurs. Infants have no frontal cavities, the rest are in an underdeveloped state. Formation occurs as the child grows and the facial bones increase. At the age of two years, the baby's frontal sinuses form and the maxillary sinuses increase in size. Upon reaching four years of age, the lower nasal passage is formed.

Formation of sinuses in children

Acute ethmoiditis(ethmoiditis acuta) - acute inflammation of the mucous membrane of the cells of the ethmoid labyrinth, occurs frequently and ranks second in frequency after inflammation maxillary sinuses. The cause of the disease is acute rhinitis, spicy respiratory diseases, influenza, etc. Predisposing factors are the anatomical and topographic location of the excretory anastomosis of the cells of the ethmoidal labyrinth, the narrowness of the middle nasal passage, curvature of the nasal septum, etc. Against this background, even slight swelling of the nasal mucosa causes difficulty in outflow from the ethmoidal cells. The anatomical proximity of the excretory anastomosis contributes to inflammation in the ethmoid cells in almost any inflammation of the paranasal sinus.

Clinic. As with any inflammatory process, acute ethmoiditis is characterized by general and local symptoms.

General symptoms characterized by an increase in body temperature (37-38 ° C), which lasts for 6-7 days, weakness, weakness. The patient may be bothered by headaches of varying intensity, most often localized in the root of the nose and orbit (pathognomic sign). These pain symptoms often depend on irritation of the sensory endings of the branches of the trigeminal nerve.

Local symptoms: nasal congestion and difficulty in nasal breathing, mucopurulent discharge from the nasal cavity, decreased sense of smell of varying severity.

IN childhood and in weakened patients or in patients with highly virulent infection, part of the bone walls ethmoid cells, swelling and hyperemia of the internal angle appear

orbit and adjacent parts of the upper and lower eyelids on the side of the disease. Here, a closed empyema (closed abscess) can form, from where pus can break into the tissue of the orbit, which is accompanied by outward deviation of the eyeball, exophthalmos, chemosis, pain when moving the eyeball, decreased vision, and increased intoxication.

Diagnostics based on characteristic complaints and anamnesis data. At anterior rhinoscopy swelling and hyperemia of the mucous membrane in the area of ​​the middle turbinate, mucopurulent discharge from under the middle turbinate or from the area of ​​the olfactory fissure with inflammation of the posterior ethmoid cells are noted. For a better examination, preliminary anemization of the mucous membrane in this area is performed. Endoscopic examination allows you to carefully examine the area of ​​exit of the natural openings of the ethmoid cells and differentiate purulent discharge from the anterior cells (anterior ethmoiditis) or posterior cells from the olfactory fissure (posterior ethmoiditis) (Fig. 2.32). On radiographs, especially with CT, darkening of the ethmoidal cells is visible. These data are most important for making a diagnosis.

Treatment. Acute ethmoiditis in the absence of complications is treated conservatively. Local treatment is aimed primarily at reducing swelling of the nasal mucosa and, therefore, improving

outflow from the affected paranasal sinuses. For this purpose, vasoconstrictor drugs are instilled into the nose. Applications to the area of ​​the middle nasal passage for 1-2 minutes of turunda soaked in an adrenaline solution work better. Combination drugs containing secretolytics, antibiotics and painkillers, in the form of endonasal sprays (rinofluimucil, isofra, polymexine with phenylephrine, etc.), and physiotherapeutic procedures (UHF, therapeutic laser) are effective. The use of the YAMIK sinus catheter is effective, allowing aspiration of the contents and administration of medications into the paranasal sinuses on the affected side. For ethmoiditis, this method is especially effective.

General treatment is indicated for elevated temperature reactions and intoxication of the body. Broad-spectrum antibiotics (Augmentin, Sumamed, Klacid, Tsipromed, etc.), hyposensitizing drugs (diphenhydramine, Gismanal, Claritin), mucolytics, and symptomatic treatment are prescribed.

If complications occur (empyema, subperiosteal abscess, phlegmon of the orbital tissue, etc.), it is necessary surgical intervention- endonasal opening of the cells of the ethmoidal labyrinth, opening of an abscess of the eyelid or orbital tissue using external or endonasal endoscopic access.

RCHR (Republican Center for Health Development of the Ministry of Health of the Republic of Kazakhstan)
Version: Clinical protocols of the Ministry of Health of the Republic of Kazakhstan - 2015

Gums of the upper jaw (C03.0), Malignant neoplasm of the paranasal sinuses (C31), Nasal cavity (C30.0), Hard palate (C05.0)

Oncology

general information

Short description

Recommended
Expert advice
RSE at the RVC "Republican Center"
healthcare development"
Ministry of Health
and social development
Republic of Kazakhstan
dated October 30, 2015
Protocol No. 14

Cancer of the nasal cavity, paranasal sinuses and ethmoid labyrinth cells- this is a malignant tumor, most often of an epithelial nature (73.2%), affecting the upper respiratory tract to the nasopharynx, as well as the maxillary, frontal, main sinuses and cells of the ethmoidal labyrinth, 26.8% connective tissue.

Malignant neoplasms of the nasal cavity and paranasal sinuses (PSN), the upper jaw account for 1-3% of malignant tumors of the head and neck, 75-95% of patients are admitted to the clinic with III-IV stage diseases. There are 58 histological types of cancer, but the most common is squamous cell carcinoma, accounting, according to various authors, 54.8-92.8%, cancer from the minor salivary glands is observed in 5.7-20% of cases. Among connective tissue tumors, the most common is esthesioneuroblastoma (61.9%), and rhabdomyosarcoma (14.3%) is less common. Melanoma of the nasal cavity is rare in 10.4% and is characterized by a less aggressive course in comparison with localizations in other organs (UD-A).

Neoplasms in the nasal cavity and paranasal sinuses develop against the background of chronic hyperplastic processes; the preceding diseases are:
· polypous rhinosinusitis with glandular fibrous polyp;
pleomorphic adenoma of the small salivary gland in the sky area;
polypous rhinosinusitis with inverted or transitional cell papilloma against the background of metaplasia and
· severe epithelial dysplasia (SED);
· chronic ulcer, perforation of the nasal septum and leukoplakia;
· chronic hyperplastic sinusitis with DTS;
· pigmented nevus, radicular or follicular cyst;
· post-radiation tissue damage;
· fibromatosis;
· chronic frontal sinusitis in combination with trauma;
· hemangioma;
osteoblastoclastoma;
· squamous cell papilloma.

According to A.U. Minkin (UD-A), background processes precede cancer in 56.7% of cases; granulations and polyps turn into cancer under the influence of constant purulent discharge. Development pathological conditions adverse factors contribute external environment, exposure (inhalation) to carcinogenic substances, physical and chemical nature, especially in a group of people associated with hazardous work, cauterization or removal of polypous tumors.

Protocol name: Malignant tumors of the nasal cavity and paranasal sinuses, ethmoid bone cells

Protocol code:

ICD-10 code(s):
C30.0 - Malignant neoplasms of the nasal cavity;
C 31 - Malignant neoplasms of the paranasal sinuses;
C03.0 - Malignant neoplasms of the gums of the upper jaw;
C05.0 - Malignant neoplasms of the hard palate.

Abbreviations used in the protocol:

Classification

ClassificationTNMcancer of the nasal cavity, paranasal sinusesand cells of the ethmoid labyrinth.

(UD-A).
T - primary tumor:
TX - insufficient data to evaluate the primary tumor;
TO - the primary tumor is not determined;
Tis - preinvasive carcinoma (carcinoma in situ).

Maxillary sinus:
T1 the tumor is limited to the mucosa without erosion or bone destruction;
T2 a tumor that erodes or destroys internal structures, including the hard palate and/or middle meatus;
T3 the tumor spreads to any of the following structures: subcutaneous tissue of the cheek, posterior wall; maxillary sinus, lower or medial wall of the orbit, ethmoid bone cells, pterygopalatine fossa;
T4a the tumor spreads to any of the following structures: anterior parts of the orbit, skin of the cheek, pterygoid plates, infratemporal fossa. cribriform plate, main or frontal sinuses;
T4b the tumor spreads to any of the following structures: apex of the orbit, dura mater, brain, middle cranial fossa, cranial nerves, except for the division of the trigeminal nerve in the upper jaw (second branch of the trigeminal nerve), nasopharynx.

Nasal cavity and ethmoid bone cells:
T1 the tumor is located within one part of the nasal cavity or ethmoid bone cells with or without bone destruction;
T2 the tumor spreads to two parts of one organ or to an adjacent part within the nasoethmoid complex with or without bone invasion;
T3 the tumor extends to the medial wall or inferior wall of the orbit, maxillary sinus, palate or cribriform plate;
T4a the tumor spreads to any of the following structures: the anterior parts of the orbit, the skin of the nose or cheek, the pterygoid plates of the main bone, the frontal or main sinuses, minimal invasion into the anterior cranial fossa;
T4b the tumor extends to any of the following structures: apex of the orbit, dura mater, brain, middle cranial fossa, cranial nerves other than the division of the trigeminal nerve in the maxilla (second branch of the trigeminal nerve), nasopharynx, or clivus.

Regional The lymph nodes:
Regional lymph nodes for the nose and paranasal sinuses are the submandibular, mental and deep cervical lymph nodes located along neurovascular bundle neck. However, malignant tumors of the nasal cavity and paranasal sinuses metastasize relatively rarely.

N - regional lymph nodes:
NX- there is insufficient data to assess the condition of regional lymph nodes;
N0- there are no signs of metastatic damage to regional lymph nodes;
N1- metastases in one lymph node on the affected side up to 3 cm or less in greatest dimension;
N2- metastases in one or more lymph nodes on the affected side up to 6 cm in the greatest dimension or metastases in the lymph nodes of the neck on both sides, or on the opposite side up to 6 cm in the greatest dimension;
N2a- metastases in one lymph node on the affected side 3.1 - 6 cm in greatest dimension;
N2b- metastases in several lymph nodes on the affected side up to 6 cm in greatest dimension;
N2с- metastases in the lymph nodes on both sides or on the opposite side up to 6 cm in greatest dimension;
N3- metastasis in a lymph node more than 6 cm in greatest dimension.

M - distant metastases:
MX - insufficient data to determine distant metastases;
M0- no signs of distant metastases;
M1- there are distant metastases.

Histopathological differentiation G:
GХ - the degree of differentiation cannot be established;
G1 - high degree differentiation;
G2- average degree of differentiation;
G3- low degree of differentiation;
G4- undifferentiated tumors.

R-classification:
The presence or absence of residual tumor after treatment is indicated by the symbol R. R classification definitions apply to all head and neck tumor sites. These definitions are as follows:
RX- the presence of residual tumor is not determined;
R0- there is no residual tumor;
R1- microscopic residual tumor;
R2- macroscopic residual tumor.
Grouping by stages:

Diagnostics

List of basic and additional diagnostic measures:
Basic (required) diagnostic examinations carried out on an outpatient basis:
· careful collection of anamnesis;
· oropharyngoscopy;
· anterior and posterior rhinoscopy;
a) CT or MRI of the paranasal sinuses, upper jaw, ethmoidal labyrinth cells, eyes, skull base
b) puncture of the maxillary sinus with cytological examination of punctate or washing fluid;
c) fiberscopic examination;
· tumor biopsy and impression smears;
· puncture biopsy.

Additional diagnostic examinations performed on an outpatient basis:
· fiberoptic bronchoscopy;
· fibrogastroduodenoscopy;
Angiography/spirography;
· CT or MRI of the chest;
· CT or MRI of the abdominal cavity;
· PET;

· X-ray of the chest organs in two projections.

Minimum list of examinations that must be carried out when referred for planned hospitalization : in accordance with the internal regulations of the hospital, taking into account the current order of the authorized body in the field of healthcare.

Basic (mandatory) diagnostic examinations carried out on stationary level(in case of emergency hospitalization, diagnostic examinations not carried out at the outpatient level are carried out):
· UAC;
· OAM;
· biochemical blood test (total protein, ALT, AST, total bilirubin, glucose, urea, creatinine);
· coagulogram;
· ECG;
X-ray of the chest organs;

Additional diagnostic examinations carried out at the inpatient level (in case of emergency hospitalization, diagnostic examinations not carried out at the outpatient level are carried out):
· CT and/or MRI from the base of the skull to the collarbone;
· CT scan of the chest with contrast (in the presence of metastases in the lungs);
· Ultrasound of the abdominal cavity and retroperitoneal space;
· EchoCG (after consultation with a cardiologist according to indications);
· UDZG (for vascular lesions).

Diagnostic measures carried out at the stage of emergency care: not carried out

Diagnostic criteria for diagnosis:
Complaints and anamnesis:
Complaints:
Difficulty in nasal breathing;
· bleeding from the nose;
· copious mucous discharge from the nasal cavity;
· the appearance of a tumor formation in the lumen of the nasal cavity;
· headache;
· foul odor;
· facial deformation;
· exophthalmos;
· bone defect of the hard palate and alveolar process of the upper jaw.
Anamnesis:
I - II stage - complaints of difficulty breathing through the nose, bleeding from the nose, copious mucous discharge from the nasal cavity, possible appearance of a tumor formation in the lumen of the nasal cavity, possibly headaches.
A CT scan or radiography reveals an additional tumor formation in the nasal cavity, or in one of the paranasal sinuses; in the second stage, destruction of a section of bone tissue is possible;
IIIstage - complaints of difficulty breathing through the nose, bleeding from the nose, copious mucous discharge from the nasal cavity, fetid odor, facial deformation, possible appearance of a tumor formation in the lumen of the nasal cavity, headaches, possibly exophthalmos.
A CT scan or radiography determines - an additional tumor formation occupying the nasal cavity extending to the medial wall or lower wall of the orbit, maxillary sinus, palate or cribriform plate;
IVstage - complaints of lack of nasal breathing, bleeding from the nose, copious mucous discharge from the nasal cavity, fetid odor, facial deformation, tumor formation in the projection of the maxillary sinus, possible appearance of a tumor formation in the lumen of the nasal cavity, headaches, possibly exophthalmos.
CT or radiography determines - an additional tumor formation occupying the nasal cavity, spreading to any of the following structures: the anterior parts of the orbit, the skin of the nose or cheek, the pterygoid plates of the main bone, the frontal or main sinuses, minimal growth into the anterior cranial fossa, the apex of the orbit, the dura meninges, brain, middle cranial fossa, cranial nerves.

Physical examination:
· external examination of the face, symmetry and configuration of the face (asymmetry of the face due to tumor deformation of soft tissues, organs, tumor germination and infiltration, disruption of the functional activity of the organ);
· anterior and posterior rhinoscopy with determination of nasal breathing (the presence and extent of a tumor process in the nasal cavity or nasopharynx, disruption of nasal breathing due to stenosis of the lumen of the nose or nasopharynx by the tumor);
· oropharyngoscopy with determination of restriction of mouth opening (the presence and extent of the tumor process in the oral cavity, oropharynx, restriction of mouth opening due to trismus as a result of the spread of the tumor to the surrounding soft tissue);
· palpation examination of the lymph nodes of the submandibular region, neck on both sides (for the presence or absence of regional metastases in the lymph nodes).

Laboratory research:
Cytology: includes a puncture biopsy of a tumor of the nasal cavity, maxillary sinus, lymph node, making fingerprint smears from the tumor and cytological examination of the tumor to determine the morphological structure of the tumor;
Histology: includes a biopsy of tumor tissue from the nasal cavity, maxillary sinus, lymph node in order to determine the morphological structure of the tumor and its degree of malignancy (histological differentiation G).
Laboratory indicators at various stages of the disease may be within normal limits.

Instrumental studies:
CT or MRI of the paranasal sinuses, upper jaw, ethmoidal labyrinth cells, eyes, skull base (to determine the localization of the tumor process and its spread to adjacent organs and tissues or other concomitant diseases, regression of the tumor process). Detection of darkening of the cavity, bone destruction, etc. is the basis for a more in-depth study;
· puncture of the maxillary sinus with cytological examination of punctate or washing fluid (to determine the morphological structure of the tumor);
· fiberscopic examination (presence of a tumor process, biopsy of tumor tissue);
· Ultrasound of the neck and abdominal organs (to exclude the presence of regional, distant metastases and concomitant diseases);
· chest x-ray (to exclude distant metastases in the mediastinum or other concomitant diseases);
· puncture biopsy of a tumor of the nasal cavity, maxillary sinus, lymph node with a cytological examination of the punctate or washing fluid; preparation of fingerprint smears from the tumor and cytological examination of the tumor to determine the morphological structure of the tumor;
· biopsy of tumor tissue from the nasal cavity, maxillary sinus, lymph node in order to determine the morphological structure of the tumor and the degree of its malignancy (histological differentiation G);
· intraoperative diagnostics includes: biopsy of tumor tissue, making fingerprint smears from the tumor and urgent histological examination of the removed tissue.
· fibrobronchoscopy (to exclude and presence of a tumor in the mediastinum and tumor biopsy);
· fibrogastroduodenoscopy (to exclude and presence of a tumor in the gastrointestinal tract, tumor biopsy, presence of concomitant diseases);
· angiography/spirography (to exclude tumor growth into the great vessels);
· CT or MRI, chest, abdominal organs, PET ((to exclude distant metastases in the mediastinum, in the abdominal cavity, or other concomitant diseases, regression of the tumor process, distant metastases.

Indications for consultation with specialists:
· consultation with a cardiologist (patients 50 years of age and older, as well as patients under 50 years of age with a cardiac history or pathological changes on the ECG);
· consultation with a neurologist (for previous strokes, traumatic brain injuries, meningitis;)
· consultation with a gastroenterologist (in the presence of erosive or peptic ulcer history of gastrointestinal organs);
· consultation with an abdominal oncologist (in the presence of metastases and tumors in the abdominal organs);
· consultation with a neurosurgeon (in the presence of metastases of the brain, spine);
· consultation with a thoracic surgeon (in the presence of metastases in the lungs and other concomitant diseases);
· consultation with an ophthalmologist (in case of local widespread tumor process in the eye, visual impairment);
· consultation with a psychologist (for cancerophobia and the presence of psychological diseases);
· consultation with an infectious disease specialist (if there is a previous infectious disease);
· consultation with a phthisiatrician (if you have or previously had tuberculosis);
· consultation with an endocrinologist (if an endocrine disease is present and detected).

Differential diagnosis

Table No. 1 . Differential diagnosis:

Treatment

Treatment goals:
· elimination of the tumor focus and metastases;
· achieving complete or partial regression, stabilization of the tumor process.

Treatment tactics:
General principles of treatment:
Multidisciplinary approach.
The initial assessment and development of a treatment plan for a patient requires a multidisciplinary team (MDT) of physicians with experience in treating this patient population. Also, the introduction and prevention of the consequences of radical surgery, radiation therapy and chemotherapy should be carried out by specialists who know these diseases - this is a surgeon-oncologist of head and neck tumors, a radiologist and a chemotherapist.
Accompanying illnesses.
They mean the presence of an intercurrent disease (in addition to a malignant tumor), which can affect the diagnosis, treatment and prognosis of the patient. Documentation of comorbidities is particularly important in oncology to prevent inaccurate determination of poor cancer treatment outcomes. Comorbidities are known to be a strong independent predictor of mortality in this group of patients, and they also influence treatment costs and quality of life.
The quality of life.
Malignant tumors impair basic physiological functions (eg, chewing, swallowing, breathing) and unique characteristics of an individual (eg, appearance and voice). Health status describes individual, physical, emotional and social capabilities and limitations. Functions and general status refers to how well an individual is able to perform important roles, tasks or activities. The concept of “quality of life” is different because the main emphasis is on the value (defined by the patient) that an individual assigns to his or her health status and functions.

Principles of surgical treatment.
Grade:
All patients should be assessed by a head and neck surgical oncologist prior to treatment to ensure the following:
· consider the adequacy of biopsy material, staging and imaging to determine the extent of tumor, exclude the presence of a synchronous primary tumor, assess current functional status and the opportunity for potential surgical treatment if primary treatment was non-surgical;
· Participate in multidisciplinary team discussions on patient treatment options with the goal of maximizing survival and maintaining form and function;
· develop a long-term follow-up plan that will include adequate dental, nutritional and healthy image life, as well as interventions and any other additional research, which are necessary for complete rehabilitation;
for patients undergoing elective surgeries, the surgical procedure, margins, and reconstruction plan must be worked out to resect a clinically detectable tumor with tumor-free surgical margins. Surgery should not be modified based on pretreatment clinical response unless tumor progression necessitates more extensive surgery to cover the tumor at the time of definitive resection.

Treatment of cancer of the nasal cavity, paranasal sinuses, and ethmoidal labyrinth cells, depending on the stage:
I-II stages (T1-2 N0). Combined treatment: Surgery using various approaches with postoperative external beam radiation therapy at a dose of 70 Gy per lesion. For poorly differentiated tumors - irradiation of the area of ​​regional metastases on the side of the tumor in a dose of 64 Gy, neoadjuvant courses of polychemotherapy followed by surgical treatment, anti-relapse courses of polychemotherapy in the postoperative period (UD - A);

Stage III (T1-2 N1 M0). Combined treatment: preoperative chemotherapy, external beam radiation therapy at a dose of 50-70 Gy to the primary lesion + external access surgery. Areas of regional metastasis on the side of the tumor are irradiated with a radiation dose of 40-64 Gy. In case of insufficient effectiveness of radiation treatment, radical cervical dissection is performed. In the postoperative period, anti-relapse adjuvant courses of polychemotherapy (UD - A);

III-IVA stages (T3-4a N0-3 M0). Option 1: Complex treatment - surgical intervention through various approaches with postoperative external beam radiation therapy at a dose of 70 Gy to the main lesion and adjuvant courses of chemotherapy (UD - A);
Option II: If there are contraindications to surgery and the patient refuses surgery, neoadjuvant courses of polychemotherapy, external beam radiation therapy with a dose of 40-70 Gy to the lesion and 64 Gy to the zone of regional lymph nodes on the affected side (N0) (UD - A), (UD - IN);
Option III: Neoadjuvant intra-arterial polychemotherapy and radiation therapy to the main lesion, SOD 50-70 Gy. (UD - B);
Option IV: Preoperative radiation therapy against the background of radiomodifying properties + surgery using various approaches, postoperative courses of polychemotherapy (UD - A), (UD - B);

IVBstage Palliative radiation therapy or chemotherapy in the setting of OOD (UD - A), (UD - B)
At various stages of the disease, radiation therapy can use external beam, 3D conformal irradiation, intensity modulated radiation therapy (IMRT). When carrying out conservative specialized chemoradiotherapy, progression of the tumor process is noted, then surgical treatment is performed.

The effect of the treatment is assessed according to WHO criteria:
· full effect- disappearance of all lesions for a period of at least 4 weeks;
· partial effect- greater than or equal to 50% reduction in all or individual tumors in the absence of progression of other lesions;
· stabilization- (no changes) a decrease of less than 50% or an increase of less than 25% in the absence of new lesions;
· progression- an increase in the size of one or more tumors by more than 25% or the appearance of new lesions.

Treatment of disease relapses.
Local relapses are treated surgically and in combination. For unresectable relapses and distant metastases, palliative chemotherapy or radiation therapy is performed. Regional lymphogenous metastases are treated surgically(radical cervical lymph node dissection) (UD - A).
In the presence of a residual tumor, radical surgery is performed, followed by postoperative radiation therapy with a dose of 70 Gy (ROD 2 Gy) to the area of ​​the primary tumor focus (the preferred option). It is also possible to carry out radiation or simultaneous chemotherapy. If clinical and instrumental examination does not reveal a residual tumor, radiation therapy is performed on the bed of the removed tumor according to a radical program. Repeated treatment is possible as a treatment option. surgical intervention followed by postoperative radiation therapy (UD - A).

Conformal radiation therapy.
Conformal irradiation (3D-conformal irradiation) is understood as irradiation when the shape of the irradiated volume is as close as possible to the shape of the tumor. That is, on the one hand, all parts of the tumor, which may have irregular shape, and on the other hand, irradiation of the tissues surrounding the tumor is minimized (“selectivity”). Thanks to this, less develops radiation complications from the healthy tissues surrounding the tumor (radiation “burn” of the skin, local cerebral edema, when irradiating the spinal cord - a decrease in radiation load on the spine).

Intensity modulated radiation therapy (IMRT).
This is a modern innovative method of radiation therapy, the essence of which is that the radiation, depending on the data obtained during computed tomography, is modulated in intensity. The advantage of this radiation method is that it allows you to accurately determine the dose of radiation that is directed to a particular area of ​​the tumor. Before this type of radiation therapy, a computed tomography scan is performed so that the contours and shape of the tumor and its relationship to surrounding tissues can be accurately determined. The data obtained using CT allows you to adjust the radiation beam and direct a higher dose to the tumor tissue.

Radiation and chemotherapy treatment depends on factors related to tumor characteristics and general condition patient. The main goals of therapy are cure of the tumor, preservation or restoration of organ functions, and reduction of treatment complications. A successful treatment outcome usually requires a multidisciplinary approach. Chemotherapy and radiation treatment should be well organized and supervised by chemotherapists and radiologists who have knowledge of the characteristics of treatment and complications in this patient population.
The patient's ability to tolerate the optimal treatment program is an important factor in the decision to undergo it.
The choice of treatment strategy is mainly made between surgical treatment, radiation therapy and combined methods.
The surgical method is acceptable only for the treatment of stage I tumors that can be radically removed with a good functional outcome. In other cases, stage I-II cancer is treated with radiation and in combination. Patients with advanced cancer always require combined or complex treatment. An integral part of the treatment of these patients are extended resections with reconstructive operations. The use of neoadjuvant chemotherapy in a number of locations or simultaneous chemotherapy and radiation treatment makes it possible to increase the number of organ-preserving interventions and transfer some initially unresectable tumors to a resectable state.

Non-drug treatment:
The patient's regimen during conservative treatment is general. In the early postoperative period - bed or semi-bed (depending on the scope of the operation and concomitant pathology). In the postoperative period - ward.
Diet table - No. 15, after surgical treatment - No. 1.

Drug treatment:
Chemotherapy is a drug treatment for malignant cancer tumors, aimed at destroying or slowing down the growth of cancer cells with the help of special drugs, cytostatics. Cancer treatment with chemotherapy occurs systematically according to a specific scheme, which is selected individually. As a rule, tumor chemotherapy regimens consist of several courses of certain combinations of drugs with pauses between doses to restore damaged body tissues.
There are several types of chemotherapy, which differ in purpose:
· neoadjuvant chemotherapy of tumors is prescribed before surgery, in order to reduce an inoperable tumor for surgery, as well as to identify the sensitivity of cancer cells to drugs for further use after surgery;
· adjuvant chemotherapy is prescribed after surgical treatment to prevent metastasis and reduce the risk of relapse;
· Curative chemotherapy is given to shrink metastatic cancers.
Depending on the location and type of tumor, chemotherapy is prescribed according to different regimens and has its own characteristics.

Indications for chemotherapy:
· cytologically or histologically verified cancer of the nasal cavity, PPN and cells of the ethmoid labyrinth;

· metastases in regional lymph nodes;
tumor recurrence;
· satisfactory blood picture in the patient: normal hemoglobin and hematocrit, absolute
number of granulocytes - more than 200, platelets - more than 100,000;
preserved liver and kidney function, respiratory system and SSS;
· the possibility of converting an inoperable tumor process into an operable one;

· improvement of long-term treatment results for unfavorable histological types of tumor (poorly differentiated, undifferentiated).

Contraindications to chemotherapy:
Contraindications to chemotherapy can be divided into two groups:
· absolute;
· relative.

Absolute contraindications:
· hyperthermia >38 degrees;
· disease in the stage of decompensation (cardiovascular system, respiratory system, liver, kidneys);
· presence of acute infectious diseases;
· mental illness;
· ineffectiveness of this type of treatment, confirmed by one or more specialists;

· serious condition the patient's Karnofsky scale is 50% or less.

· pregnancy;
· intoxication of the body;


· cachexia.

Below are diagrams of the most commonly used polychemotherapy regimens for cancer of the nasal cavity, PPN and ethmoidal labyrinth cells. They can be used during both neoadjuvant (induction) chemotherapy and adjuvant polychemotherapy, followed by surgery or radiation therapy, as well as for recurrent or metastatic tumors.
The main combinations used in induction polychemotherapy today are cisplatin with fluorouracil (PF) and docetaxel with cisplatin and fluorouracil (DPF). This combination of chemotherapy drugs has become the “gold standard” when comparing the effectiveness of various chemotherapy drugs in the treatment of squamous cell carcinoma head and neck for all large multicenter studies. The latter scheme seems to be the most effective, but also the most toxic, but at the same time provides more high performance survival and locoregional control compared with the use of the traditional PF regimen as induction polychemotherapy (UD-A).
Among the targeted drugs, cetuximab (UD-A) has now entered clinical practice.
According to the latest data, the only combination of chemotherapy drugs that not only increases the number of complete and partial regressions, but also the life expectancy of patients with relapses and distant metastases of squamous cell carcinoma of the head and neck is a regimen using cetuximab, cisplatin and fluorouracil (UD-A).

Table No. 2. Activity of drugs in monotherapy in recurrent/metastatic squamous cell carcinoma (modified according to V.A. (Murphy) (UD-A):

Drugs (active ingredients) used in treatment

Hospitalization

Indications for hospitalization:
Indications for planned hospitalization: morphologically verified cancer of the nasal cavity and paranasal sinuses, subject to specialized treatment with clinical group II.

Indications for emergency hospitalization: morphologically verified cancer of the nasal cavity or paranasal sinuses with bleeding or pain in clinical group II.

Prevention

Preventive actions:
Early start of treatment, its continuity, comprehensive nature, taking into account the patient’s individuality, the patient’s return to active work.
The use of medications to restore the immune system after antitumor treatment (antioxidants, multivitamin complexes), a nutritious diet rich in vitamins and proteins, giving up bad habits (smoking, drinking alcohol), preventing viral infections and concomitant diseases, regular preventive examinations with an oncologist, regular diagnostic procedures(radiography of the lungs, ultrasound of the liver, kidneys, neck lymph nodes) .

Information

Sources and literature

1. Minutes of meetings of the Expert Council of the RCHR of the Ministry of Health of the Republic of Kazakhstan, 2015
   1. List of used literature: 1. A.I. Paches. Tumors of the head and neck. Clinical Guide. Fifth edition. Moscow 2013 from 322-339; 2. D.H. Savkhatov. Issues of timely diagnosis of malignant neoplasms of the upper respiratory tract. Almaty 1999 p.8; 3.A.U.Minkin. Environmental aspects and solutions to the problem early detection and organ-preserving treatment of malignant tumors of the upper jaw and paranasal sinuses. Materials of the scientific and practical conference “Diagnostics and treatment of malignant tumors of the nasal cavity and paranasal sinuses” 06/7/2011. Siberian Oncology Journal 2001; 6(48); 4.NCCN Clinical Practice Guidelines in Oncology: head and neck. Available at Accessed March 2011; 5.Bonner JA, Harari PM, Giralt J, et al. Cetuximab prolongs survival in patients with locoregionally advanced squamous cell carcinoma of head and neck: A phase III study of high dose radiation therapy with or without cetuximab (abstract). ASCO Annual Meeting Proceedings (post-meeting edition). J Clin Oncol 2004;22:5507; 6.Greene FL, Page DL, Fleming ID, et al (eds). AJCC Cancer Staging Manual, Sixth Edition Springer-Verlag: New York 2002; 7. Colasanto JM, Prasad P, Nash MA, et al. Nutritional support of patients undergoing radiation therapy for head and neck cancer. Oncology 2005;19:371-382; 8.Medical clinical guidelines European Society of Medical Oncologists (ESMO. Moscow 2006); 9.Piccirillo JF, Lacy PD, Basu A, et al. Development of a new head and neck cancerspecific comorbidity index. Arch Otolaryngol Head Neck Surg 2002;128:1172-1179; 10.American Joint Committee on Cancer (AJCC). AJCC Cancer Staging Manual, 7th ed. Edge S.B., Byrd D.R., Carducci M.A. et al., eds. New York: Springer; 2009; 11.Murphy B.A Carcinoma of the head and neck. In: Handbook of cancer cancer. Skeel R.T., Khleif S.N. (eds). 8th Edition. Lippincott Williams & Wilkins.2011: 69-63; 12. Guide to chemotherapy of tumor diseases. Edited by N.I. Perevodchikova, V.A. Gorbunova. 4th edition, expanded and expanded. Practical medicine. Moscow 2015; 13.Forastiere A.A., Goepfert H., Maor M. et al. Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer. N Engl J Med.2003; 349:2091-2098; 14. Blanchard P., Bourhis J., Lacas B. et al. Taxan-Fluorouracil as induction of chemotherapy in locally advanced head and neck cancers: an individual patient data meta-analysis of the meta-analysis of chemotherapy in head and neck cancer group. J Clin Oncol. 2013; 31(23): 2854-2860; 15.Vermorken J.B., Mesia., Rivera F. et al. Platinum-based chemotherapy plus cetuximab in head and neck cancer. N Engl J Med. 2008; 359 (11): 1116-1127; 16.Forastiere A.A., Goepferi H., Maor M. et al. Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer. N Engl J Med. 2003; 349: 2091-2098; 17. Bonner J. A., Harari P. M., Giralt J. et al. Radiotherapy plus cetuximab for squamous-cell carcinoma of the head and neck. N.Engl. J. Med. 2006; 354(6): 567-578; 18.American Joint Committee on Cancer (AJCC). AJCC Cancer Staging Manual, 7th ed. Edge S.B., Byrd D.R., Carducci M.A. et al., eds. New York: Springer; 2009; 19. Adilbaev G.B., Kim G.G., Kaibarov M.E., Mukhambetov M.M., Sadykov S.S. The role of neoadjuvant polychemotherapy and radiotherapy with radiomodification in complex treatment cancer of the maxillary sinus //V Congress of Oncologists and Radiologists of the CIS, May 14-16, Tashkent 2008. P. 149; 20. Konstantinova M.M.. Chemotherapy for squamous cell carcinoma of the head and neck. St. Petersburg medical Academy postgraduate education. Practical Oncology T.4, No. 1-2003 p. 25; 21. Adilbaev G.B., Kim G.G., Mukhambetova G.A.. Ways to improve the results of complex treatment of locally advanced cancer of the maxillary sinus // Bulletin of the Russian Cancer Research Center named after. N. N. Blokhina RAMS, 2009 v. 20, No. 2 (Appendix 1), p. 54, Proceedings of the Eurasian Congress on Head and Neck Tumors, 2009, Minsk, Belarus; 22. Vdovina S.N., Andreev V.G., Pankratov V.A., Rozhnov V.A. .Combined treatment of malignant tumors of the nasal cavity and paranasal sinuses using preoperative radiation therapy against the background of radio-modifying properties.//Siberian Journal of Oncology No. 1 2006 p. 25; 23. Molotkova N. G. Radiation and combined treatment of malignant tumors of the upper jaw and nasal cavity. Abstract. Dissertation for the scientific degree of kmn; Obninsk 1996 24. Sdvizhkov A.M., Finkelshtern M.R., Pankin I.V., Borisov V.A., Gurov S.N. Intra-arterial regional chemotherapy in the complex treatment of patients with malignant tumors of the nasal cavity, paranasal sinuses and oral cavity. Siberian Oncology Journal No. 1 2006 page 113; 25. Kropotov M.A. General principles of treatment of patients with primary head and neck cancer. RONC named after. N.N. Blokhin RAMS, Moscow. Practical Oncology T4, No. 1-2003; 26.Posner M.R., Hershor D.M., Blajman C.R. et al. Cisplatin and fluorouracil alone or with docetaxel in head and neck cancer. N Engl J Med. 2007; 357(17):1705-1715. 27. Kholtoev U.T. Features of the clinic and treatment of patients with malignant tumors of the upper jaw with invasion into the orbit. Abstract. Dissertation for the scientific degree of kmn. Moscow. 2002

Information

List of protocol developers with qualification information:

1.

Adilbaev Galym Bazenovich - Doctor of Medical Sciences, Professor, "RSE at PCV Kazakh Scientific Research Institute of Oncology and Radiology", head of the center;
2. Akhmetov Daniyar Nurtasovich - Candidate of Medical Sciences, RSE at the Kazakh Scientific Research Institute of Oncology and Radiology, oncologist;
3. Tumanova Asel Kadyrbekovna - Candidate of Medical Sciences, RSE at the Kazakh Scientific Research Institute of Oncology and Radiology, head of the department of day hospital chemotherapy -1.
4. Savkhatova Akmaral Dospolovna - RSE at the RPE "Kazakh Scientific Research Institute of Oncology and Radiology", head of the day hospital department.
5. Makhishova Aida Turarbekovna - Candidate of Medical Sciences, RSE at the PVC "Kazakh Scientific Research Institute of Oncology and Radiology", researcher.
6. Tabarov Adlet Berikbolovich - clinical pharmacologist, RSE at the RPE "Hospital of the Medical Center Administration of the President of the Republic of Kazakhstan", head of the department of innovative management.

Disclosure of no conflict of interest: No

Reviewers: Yesentaeva Suriya Ertugyrovna - Doctor of Medical Sciences, head of the course of oncology, mammology of the National Educational Institution "Kazakhstan - Russian Medical University"

Indication of the conditions for reviewing the protocol: Review of the protocol 3 years after its publication and from the date of its entry into force or if new methods with a level of evidence are available.

Annex 1
Assessment of the general condition of the patient using the Karnofsky index

Mobile application "Doctor.kz"

Attached files

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When examining the skull from the outside, the ethmoid bone is not visible - it is covered by the bones of the facial skull. This bone is presented in the singular, but consists of two approximately identical parts, symmetrical relative to the vertical median plane.

In each of the halves there are cavities filled with air, which are called ethmoidal (ethmoidal) sinuses or labyrinths of the ethmoid bone. Why? Because, unlike other paranasal sinuses, they consist of bone cells, which are usually from 8 to 10, and their shape is individual for each person. Conventionally, the ethmoid labyrinth is divided into three sections: anterior, middle and posterior. The cells of the posterior section communicate with the superior nasal passage, and the anterior and middle cells open into the middle nasal passage.

The ethmoid bone is adjacent to several anatomical structures, such as the optic nerve, sphenoid and frontal bones, orbits, maxillary sinuses, and sometimes the anterior cranial fossa. This arrangement of the ethmoid labyrinth, with inadequate treatment of ethmoiditis, contributes to the spread of the pathological process into the cranial cavity, onto the optic nerve or into the orbit.

The inner surface of the cells of the ethmoid bone is covered with a mucous membrane, the inflammation of which is called ethmoiditis. The differences between the mucous membrane of the labyrinth and that of the nasal cavity are as follows: it is thinner, it has fewer glands and blood vessels.

Ethmoiditis can begin acutely and, with proper and timely therapy, end quite quickly. But this does not always happen - the disease often takes a chronic course.

In terms of frequency of occurrence, ethmoiditis is second only to sinusitis. By virtue of anatomical structure and the location of the ethmoid bone, it is rarely isolated, often combined with frontal sinusitis and inflammation of the maxillary sinuses. And vice versa: the inflammatory process, starting in any of the paranasal sinuses, often spreads to the cells of the ethmoid labyrinth.

Acute ethmoiditis

Etiology of the disease

The cause of acute inflammation of the mucous membrane of the ethmoid sinuses (acute ethmoiditis) can be any inflammatory process in the nasopharynx, upper respiratory tract or adjacent organs, for example, rhinitis, tonsillitis, adenoiditis, pharyngitis, otitis media, etc.

The risk of developing ethmoiditis is much higher in people who are weakened by frequent colds or concomitant chronic diseases immunity. The development of ethmoiditis is facilitated by structural anomalies of the ENT organs, adenoid growths in the nasopharynx and other factors that reduce natural ventilation and impair the drainage of the ethmoid sinuses.

The slightest swelling of the mucous membrane of the ethmoid cells entails disruption of the function of natural anastomosis, stagnation of mucus in the sinuses and the proliferation of pathogenic microorganisms in them.

Clinical signs and possible complications

Acute ethmoiditis begins with an increase in body temperature to 37.5-38 °C, the appearance of weakness, and a feeling of weakness throughout the body. Then to general symptoms headaches occur, the peculiarity of which is their localization in the root of the nose. This distinguishes ethmoiditis from other sinusitis. The pain either weakens or intensifies and “spreads” throughout the head. The sense of smell worsens, nasal congestion progresses, making breathing difficult. Discharge from the nasal passages is mucopurulent or purulent in nature. Fever bodies are sometimes registered for a week.

Important! If you experience the clinical symptoms described above against the background of ARVI or any other disease, never self-medicate. Even if you guess that this is inflammation of the paranasal sinuses, do not try to cure ethmoiditis at home. By contacting an otolaryngologist, you will protect yourself from the serious consequences of ethmoiditis. Among all sinusitis, it ranks first in the incidence of intracranial complications.

When the thin bone walls of the labyrinth melt, the infection spreads along the neurovascular bundles or through the blood and lymphatic vessels, ethmoiditis can result in the development of orbital and intracranial complications.

The first group includes orbital osteoperiostitis, swelling of the orbital tissue, abscesses and phlegmons, thrombosis of the orbital veins, etc. Clinical signs of the transition of purulent inflammation to the orbit are swelling and redness of the eyelids and conjunctiva, protrusion of the eyeball and its deviation upward or to the side. Pain in the eye occurs even with light pressure on it; it prevents you from moving your gaze down, up or to the side. General health worsens: fever returns to 39 °C and higher, sometimes with vomiting and chills, severe headaches, weakness increases, and malaise intensifies.

Intracranial complications of ethmoiditis can be purulent meningitis, brain abscess, extradural (under the hard meninges) abscess. Clinically, they are manifested by an increase in body temperature, the occurrence of local or diffuse (over the entire head) headache, accompanied by vomiting or nausea, the appearance of neurological symptoms (convulsions, loss of consciousness, etc.). Swelling of the eyelids and redness of the mucous membrane of the eyes, displacement of the eyeball, and pain when changing the position of the eyes may be observed. Similar symptoms occur with thrombosis of the cerebral venous sinus.

A life-threatening complication, the development of which without treatment can result in ethmoiditis, is sepsis. If, against the background of a clearly expressed clinical picture of ethmoiditis, body temperature rises sharply and does not fall, accompanied by chills, headaches and severe sweating, if signs of inflammation appear internal organs(kidneys, heart, liver, etc.), the doctor first of all excludes or confirms sepsis.

All patients with complications of ethmoiditis are patients in specialized departments who are subject to emergency qualified medical care.

How does a doctor diagnose acute ethmoiditis?

The diagnostic steps for suspected acute ethmoiditis are as follows:

1. Having identified complaints and asked the patient about the development of the disease, the doctor proceeds to a general examination of the patient, and then to a targeted examination of the ENT organs and paranasal sinuses, including.
2. With ethmoiditis, as with other sinusitis, the nasal mucosa is swollen. The use of vasoconstrictors improves visualization of intranasal structures. Mucopurulent discharge drains from under the upper (in case of inflammation of the posterior cells) or from under the middle (in case of inflammation of the anterior and middle cells) nasal concha. The doctor may use an endoscope to take a closer look at the natural openings of the ethmoid sinuses.
3. To confirm the diagnosis of acute ethmoiditis, as well as to identify orbital and intracranial complications, the patient is referred for an X-ray or CT scan. The darkening of the cells of the ethmoidal labyrinth, detected in the images, is important for the doctor diagnostic criterion, indicating in favor of ethmoiditis.
4. Confirmation of an acute inflammatory process in the ethmoid sinuses is an increase in ESR, an increased content of leukocytes and characteristic changes leukocyte formula in clinical analysis blood.
5. If meningitis, venous sinus thrombosis and abscesses are suspected, a spinal puncture is indicated, and if sepsis is suspected, a three-fold bacteriological blood test is indicated.

Treatment of acute ethmoiditis

The basis of treatment for uncomplicated acute ethmoiditis is conservative methods, aimed primarily at combating swelling of the mucous membrane and restoring the natural drainage of the labyrinth cells, as well as drugs that act on the causative agent of the disease.

The main directions in the treatment of acute ethmoiditis are as follows:

• anemization of the mucous membrane through applications (turundas into the nasal passages) or instillations (instillation into the nasal passages) of a solution containing adrenaline;
• the use of ready-made combined nasal drops, which include antibiotics, mucus-thinning secretolytics, and analgesics;
• carrying out medical procedures using a YAMIK sinus catheter, during which the doctor evacuates the pathological contents from the affected sinuses and then injects medications into them;
• physiotherapy (laser, UHF, etc.);
• prescribing antibiotics (orally or by injection), antihistamines and symptomatic drugs (orally) in the case of a detailed clinical picture of acute ethmoiditis and severe intoxication of the body. When choosing an antibiotic, preference is given to drugs with a broad spectrum of antibacterial action.

In case of complications of acute ethmoiditis, emergency surgical intervention cannot be avoided. An autopsy is always performed ethmoid sinuses with access through the nose with removal of pathological contents and the formation of an artificial wide anastomosis. All abscesses must be opened and drainage installed. In parallel, massive antibacterial and symptomatic therapy is prescribed.

Important! Do not try to cure ethmoiditis solely on your own at home. Proven folk remedies are quite effective, but only in combination with drug treatment prescribed by a qualified ENT doctor.

Chronic ethmoiditis

Causes of development of chronic ethmoiditis

The main reason for the development of a chronic inflammatory process in the ethmoid sinuses is missed or poorly treated. It happens that chronic ethmoiditis forms as a complication of other sinusitis. This occurs due to the fact that the ethmoidal labyrinth occupies a central position in relation to all other paranasal sinuses and is in close contact with them.

Contributing to the chronicity of the inflammatory process are weakened immunity, anatomical abnormalities in the nasopharynx, adenoids, and exposure to harmful production factors etc.

Clinical picture of the disease

The most common clinical forms of chronic ethmoiditis are purulent, serous-purulent and hyperplastic forms. The mucous membrane of the middle nasal passages suffers the most: it thickens, and polypous growths appear on it. There can be so many polyps that, putting constant pressure on the walls of the nose, they deform it. Sometimes polypous vegetations are visible even to the naked eye through the nostrils.

Chronic uncomplicated ethmoiditis is characterized by a sluggish course, and even during an exacerbation a bright clinical symptoms absent. There may be pain and a feeling of heaviness in the root of the nose, which intensifies when the head is tilted to the left and right, and mucopurulent discharge from the nose is noted. But complications immediately make themselves felt with pronounced general symptoms, namely increased body temperature, weakness, chills, etc.

Diagnosis and treatment of chronic ethmoiditis

The doctor makes a diagnosis of the disease based on an analysis of complaints, anamnestic data, and the results of an examination of the patient ( general examination, rhinoscopy, endoscopic methods) and results additional methods examinations (radiography, CT). Their significance is very great, since there is no puncture method for diagnosing diseases of the ethmoid sinuses.

If chronic ethmoiditis proceeds without complications, then treatment of exacerbations is similar to that for an acute disease (antibiotics, vasoconstrictor and complex nasal drops, YAMIK procedures, etc.). The exception is physiotherapeutic methods - they are contraindicated in the polyposis form of chronic ethmoiditis.

If conservative treatment does not produce the desired results, surgical intervention is performed. This may be opening the cells of the labyrinth, removing polyps, excision of pathologically changed areas of the middle and lower nasal conchas, or others. All these operations are performed under anesthesia and using modern endoscopic optical systems and special microscopes.

Polypous chronic ethmoiditis often recurs after surgery. Therefore in postoperative period immunocorrectors and corticosteroids are prescribed.

The methods of traditional medicine described in the section “Folk Remedies” have proven themselves well in the treatment of ethmoiditis. But you shouldn’t conduct experiments on yourself by endlessly steaming in a bathhouse or, overcoming disgust, attending hirudotherapy sessions. Consult your ENT doctor, and he will definitely tell you which achievements of traditional medicine should be given preference specifically in your case.