Faciocranial complications of sinusitis

Abstract

Sinusitis is one of the most common conditions. The aetiology of sinusitis has not been fully discovered; however, viruses and bacteria are usually the dominant causes. The chief symptoms include nasal congestion, profuse nasal discharge and a compromised sense of smell. Inflammation of any sinus can be the source of complications. Complications develop usually as a result of exacerbation of chronic sinusitis. Sinusitis may result in inflammation spreading inside the cranium and to the orbital area and in the development of osteomyelitis or superior sagittal sinus thrombosis. Due to the anatomical location and proximity of important structures, sphenoid sinusitis may lead to meningitis or subdural empyemas, temporal lobe abscesses and cavernous sinus thrombosis. Fungal sinusitis is very dangerous since it is characterised by a rapid course often complicated by intracranial and orbital spread. Invasive fungal paranasal sinusitis with orbital complications is a life-threatening emergency. If there is concern about possible orbital or intracranial complications of sinusitis or if there is no improvement after initial empirical therapy, the use of diagnostic imaging is necessary, including computed tomography and magnetic resonance imaging. Early diagnosis of sinusitis and multidisciplinary management involving a combination of antibiotic therapy and surgical treatment, including neurosurgery and maxillofacial procedures can be effective in the prevention of complications and may significantly reduce morbidity and mortality.