Traditional Culture Encyclopedia - Photography major - The fossa between the upper eyelid and eyebrows always hurts, but there is no sinusitis after examination. What's going on here?
The fossa between the upper eyelid and eyebrows always hurts, but there is no sinusitis after examination. What's going on here?
Acute frontal sinusitis may cause general symptoms such as loss of appetite, mental fatigue or lethargy, general malaise, chills, fever, etc. And the onset is urgent and heavy; Accompanied by nasal congestion, runny nose, olfactory disorder, headache and other local symptoms; Local pain and headache have their own characteristics: at the initial stage of onset, there may be overall headache or orbital jumping pain first, and then pain in the upper orbital angle and forehead may be felt. Headache in the early stage of the disease occurs regularly, that is, the pain in the forehead of the affected side often begins to get worse after getting up in the morning, and it is the most intense at noon, and gradually decreases in the afternoon and disappears at night. If the inflammation does not disappear, the daily symptoms will appear in the same pattern for more than ten days. Why? Because when the human body stands upright, the frontal sinus orifice is located at the bottom wall, like an inverted narrow-necked bottle. When sleeping on your back at night, purulent secretions in the sinus cavity are not easy to discharge and accumulate at the bottom of the sinus. In the process of slow discharge through the ostium of the sinus, negative pressure or even vacuum will be formed in the sinus. Coupled with the stimulation of purulent secretions, the so-called "vacuum headache" will appear. Since the human body is in an upright position from morning to afternoon, gravity will help the forehead. In acute frontal sinusitis, the forehead and upper eyelid can be red and swollen, and the upper corner of the orbit has tenderness and stabbing pain; Nasal examination: the mucosa at the front end of the middle turbinate is obviously red and swollen, and there may be pus in the middle nasal passage. In chronic frontal sinusitis, systemic symptoms and local symptoms may be mild or not obvious.
Treatment (1) Non-surgical treatment includes nasal drops plus nasal mucosa vasoconstrictor and antibiotics, replacement, physical therapy, etc. , may only be effective for early mild symptoms.
(2) Intranasal surgery includes correcting the height curvature of nasal septum, nasal polypectomy, partial middle turbinectomy, etc. This operation is suitable for patients with chronic suppurative frontal sinusitis who are ineffective in non-surgical treatment, but not for patients with a history of frontal sinus injury and complications. This kind of surgery is also called auxiliary surgery.
(3) Patients undergoing frontal sinus intranasal surgery lie on their backs. Under the anesthesia of the inner nasal surface or general anesthesia, a V-shaped incision is made at the nasal root of the lateral nasal wall to peel off mucosa, remove uncinate process and open the anterior ethmoid sinus. In case of turbinate hypertrophy, the middle turbinate should be broken and displaced first, or the middle turbinate should be partially removed, and the posterior edge of maxillary process should be chiseled to enlarge the nasofrontal canal. Pay attention to the inner and posterior cribriform plates of nasofrontal canal during operation, reset the mucosal flap after operation, drain the frontal sinus with 6mm silicone tube, and rinse it after 6 days. This operation is relatively simple. Mucosal injury is less and safer, and it is not easy to cause nasofrontal canal stenosis, and there will be no scar on the forehead, so it is not necessary to do more complicated intranasal frontal sinus surgery. If the effect is not good, frontal sinus surgery is feasible.
(4) Extranasal surgery (radical frontal sinus surgery)
65438 0. Lynch operation
(1) indication
(1) The patients whose nasal operation and frontal sinus operation are ineffective;
② Patients with chronic frontal sinusitis complicated with osteomyelitis or fistula;
③ Chronic frontal sinusitis with orbital or intracranial complications;
④ Fungal frontal sinusitis;
⑤ Forehead sinus foreign body and frontal sinus fracture.
(2) During the operation, the patient lay on his back, his face was disinfected with alcohol, the nasal mucosa was anesthetized with surface, and the inner canthus and eyebrow arch were anesthetized with 1% procaine or lidocaine plus a few drops of 0. 1% adrenaline. The eyebrows were not shaved, and the affected eyes were covered with a surgical towel. The strength and eye conditions were observed at any time during the operation.
Cut along the eyebrow and turn the inner end slightly below the medial canthus plane of the frontal process of the maxilla. Don't hurt the orbital wall when peeling off the periosteum. Carefully peel off the lacrimal sac and the upper oblique pulley about 0.5cm deep in the upper corner of the orbit, move them to the inside and cover them with a small piece of gauze for protection. After proper treatment, the lacrimal bone and ethmoid cardboard were exposed inward and the anterior ethmoid artery was ligated. Chisel out the base of frontal sinus, enter the frontal sinus, peel off the diseased mucosa, and chisel out the frontal process, lacrimal bone and ethmoid board to complete the opening of ethmoid sinus. If necessary, the anterior wall of sphenoid sinus can be excavated to facilitate sphenoid sinus drainage and treat inflammation. Finally, a 0.6cm thick silicone drainage tube was inserted, and the skin and subcutaneous tissue were sutured in two layers with silk thread. Before suturing the incision, pay attention to restore the upper inclined pulley to its original position to avoid diplopia after operation.
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