Complicatii ale inflamatiilor acute ale cailor aeriene superioare
de Prof. Dr. Dorin Sarafoleanu
Clinica ORL si Chirurgie Cervico-faciala "Sf. Maria", Bucuresti
Complicatiile rinosinuzitelor sunt clasificate in literatura de specialitate astfel: Complicatii oculo-orbitale; Complicatii endocraniene; Complicatii ototubare jogos casino online.
Complicatiile oculo-orbitale se pot clasifica in ordinea gravitatii si a progresiunii evolutive ca: edem palpebral; celulita orbitala; abces subperiostal; abces orbital; tromboza sinusului cavernos Bonus Fara Depunere
Edemul pleoapelor este complicatia cea mai frecventa. Are simptomele unei sinuzite acute in evolutie, se amplifica. Apar semnele locale, edemul palpebral, ingustarea fantei palpebrale, diminuarea motilitatii globului ocular, tulburari de vedere. Aceste fenomene sunt consecinta unei obstructii venoase la nivelul etmoidului.
Aceasta obstructie venoasa favorizeaza localizarea infectiei la celulele preseptale. Celulele preseptale, impreuna cu tarsul palpebral au rol de protectie antiinfectioasa a continutului orbitei. Odata depasita aceasta bariera, se declanseaza celulita orbitala, in care orbita este
invadata de infectie.
Se produce un edem inflamator difuz al intregului continut orbital, care apoi se infecteaza. De asemenea, apar ptoza palpebrala, protruzia globului ocular, chemosis, modificari de motilitate oculara, tulburari de vedere.
Abcesul subperiostal reprezinta aparitia puroiului in tesuturile moi si in cavitatea orbitala, semnele clinice descrise anterior accentuandu-se. Apar fenomene de necroza in diverse segmente ale orbitei, in timp ce chemosisul se mareste, aptoza este completa, globul ocular devine fix, tulburarile de vedere se accentueaza.
Se produce si o obstructie a vaselor retinei, apar fenomene de nevrita optica si in final orbirea.
Tromboza sinusului cavernos apare ca urmare a infectiei venelor comunicante orbitale care fac legatura cu sinusul cavernos. Simptomatologia trombozei de sinus cavernos este severa, evolueaza rapid si consta in: chemosis accentuat, progresiv; ptoza palpebrala totala; fixitatea globului ocular; desen venos accentuat palpebral si periorbital; posibila aparitie a unei celulite la ochiul opus; accentuarea sepsisului; semne de meningita; orbire si chiar moarte.
Complicatiile oculo-orbitale beneficiaza de tratament medicamentos, chirurgical si combinat. Tratamentul medicamentos poate include antibioterapie, decogestionante sistemice, decogestionante locale, comprese reci pe zona afectata, dezinfectie nazala, umidificare, hidratare, antiinflamatoare si analgezice.
Tratamentul expus este eficace si poate rezolva cu restitutio ad integrum edemul palpebral, celulita orbitala si abcesul subperiostal.
Abcesul orbital si tromboza sinusului cavernos impun interventia chirurgicala. Tratamentul chirurgical se impune in cazurile de abces orbital confirmat de C.T., deteriorarea vederii, reactie redusa la tratamentul medicamentos, invadarea ochiului opus.
Chirurgia endoscopica rino-sinusala FESS si abordul endoscopic al orbitei rezolva complet aceste situatii. Tratamentul combinat reprezinta terapia pre-, intra- si postoperatorie necesara pana la vindecarea completa si include mijloacele terapeutice deja enumerate.
Complicatiile endocraniene ale rinosinuzitelor sunt: meningita, abcesul epidural, abcesul subdural, tromboza sinusurilor venoase craniene, abcesul cerebral.
Clinicianul trebuie sa cunoasca posibilitatea unor astfel de posibile complicatii in cursul evolutiei unei rinosinuzite. Aparitia simptomelor neurologice obliga adoptarea unei conduite de urgenta corespunzatoare.
Complicatiile ototubare ale rinosinuzitelor sunt impartite in obstructia tubara acuta si otita seroasa. In evolutia unei rinosinuzite acute sau cronice reacutizate, poate sa se instaleze o obstructie tubara acuta.
Infectia de la nivelul mucoasei rinosinusale se poate extinde la mucoasa tubara, determinand obstructia acesteia. Prin obstructia sa, compromite atat functia equipresiva, cat si functia de drenaj a trompei lui Eustachio.
In aceste conditii, in urechea mijlocie apar edemul mucoasei casei timpanului, transudat seric, diminuarea mobilitatii lantului osicular, modificari ale timpanului.
Toate aceste modificari determina otita seroasa care poate aparea in cursul unei inflamatii infectioase, alergice sau combinate a mucoasei nasului si sinusurilor. Aceasta se manifesta clinic prin senzatia de tensiune in ureche, durere auriculara, surditate, acufene de tonalitate joasa, clacment auricular in timpul deglutitiei.
Examenul otoscopic poate evidentia un timpan retractat, in faza de rezorbtie aeriana pretransudativa din casa timpanului, sau un timpan bombat, rosu, cu stergerea detaliilor anatomice, in faza de epansament al casei timpanului.
Simptomatologia si semnele obiective clinice si audiometrice pot dispare rapid o data cu rinosinuzita cauzatoare daca aceasta este corect tratata.
in anumite situatii, se impune evacuarea prin timpanotomie a secretiilor din urechea mijlocie.
In conditiile unui tratament incomplet sau a neglijarii suferintei, otita seroasa evolueaza spre cronicizare, se transforma in otita sero-mucoasa, cu implicatii importante in auzul pacientului si cu probleme de tratament mult mai ample, mai complicate si mai costisitoare.
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