REFERAT

INFLAMMATORY FACTORS OF SINUSITIS

Oleh :
M. Yudhistira Arief Rakhman I4A012099
Rizkina Hayati I4A013024
Nurmila Khalishah I4A013090

Pembimbing :
dr. Nur Qamariah, Sp.THT-KL

SMF/Bagian Ilmu Penyakit THT

FK ULM/RSUD Ulin Banjarmasin
Februari, 2018
Introduce
• Sinusitis is considered as one of the most common causes of health disorders in the
world
• Data from DEPKES RI in 2003 found that nasal and sinus disease were in the 25th of
50 major diseases or about 102,817 outpatients in hospitals.
• Various etiologies and predisposing factors play a role in the onset of this disease,
such as septal deviation, nasal polyps, nasal and nasopharyngeal tumors and
allergies
• Only 25% is caused by infection, the remaining 75% is caused by allergies
Definition
• Sinusitis is an inflammation of the paranasal sinuses
• Chronic sinusitis differs from acute sinusitis in various aspects, generally difficult to
cure with medical treatment. In acute sinusitis, pathologic changes of the mucous
membrane are polymorphonuclear infiltrates, vascular congestion and surface
epithelial desquamation, all of which are reversible.
1. Maxillary Sinuses
• The maxillary sinus is the largest paranasal sinus. The maxillary sinus is triangular.
The anterior wall of the sinus is the facial surface of the maxillary os called the fossa
kanina, the posterior wall is the maxillary infra-temporal surface, the medial wall is
the lateral wall of the nasal cavity, the superior wall is the orbital floor and the
inferior wall is the alveolaris and palate processus. The maxillary sinus ostium is
adjacent to the superior medial wall of the sinus and empties into the semilunar
hiatus through the etmoid infundibulum.
• The largest blood supply through the branches of the maxillary artery. Inerve the
sinus mucosa through the branches of the maxillary nerve.
Frontal sinuses
• Frontal sinuses located on the frontal os begin to form from the fourth month of the
fetus, derived from the frontal resessal cells or from the etmoid infundibulum cells.
The frontal sinus is separated by a relatively thin bone of the orbital and anterior
cerebral fossa, so the infection of the frontal sinus is easily spread to this area. The
frontal sinus is drained through its ostium located in the frontal resessus. The frontal
resess is part of the anterior etmoid sinus.
• Blood supply is obtained from the supraorbital artery and the supratrochlear artery
originating from the ophthalmic artery which is one of the branches of the internal
carotid artery. Mucosal inservation is supplied by supraorbital branches and branch
supratrochlear from the frontal nerve derived from the trigeminal nerve.
Ethmoidalis Sinus
• Based on its location, the etmoid sinus is divided into the anterior sinus etmoid that
empties into the meatus medius and the posterior etmoid sinus that empties into
the superior meatus. The anterior etmoid sinus cells are usually small and large,
located below the attachment of the conjunctive medium, whereas the posterior
etmoid sinus cells are usually larger and fewer in number and are located in the
postero-superior attachment of the media. At the forefront of the anterior etmoid
sinus there is a narrow section, called the frontal resessus, which corresponds to the
frontal sinus. The etmoid sinus roof called fovea etmoidalis borders the lamina
kribosa. The lateral wall of the sinus is a very thin lamina papirasea and limits the
etmoid sinus of the orbital cavity. On the back of the posterior etmoid sinus borders
the sinus sphenoid.
• The blood supply comes from the nasal branch of the sphenopalatine artery.
Mucosal conservation comes from the ophthalmic and maxillary divisions of the
trigeminal nerve.
Sphenoidal Sinus
• The sinus sphenoid is located in the sphenoid os behind the posterior etmoid sinus.
The sphenoid sinus is divided by a partition called the intersphenoid septum. Its size
is 2 cm in height, the depth is 2.3 cm and the width is 1.7 cm. The volume varies
from 5 - 7.5 ml.
ROLE OF INFLAMMATORY MEDIATORS
• Fast-phase allergic reactions (RAFC) and slow-phase allergic reactions (RAFL) in
allergic rhinitis are characterized by symptoms of sneezing, runny nose, and nasal
congestion. These symptoms are due to the performance of histamine and various
other mediators.
• Sneezing
• Pruritus
• Rhinnorhea
• Nasal congestion
Sneezing
• Histamine is a major mediator of sneezing. Sneezing is generally a symptom of RAFC.
• Sneezing is caused by stimulation of H1 receptors on the nerve endings of vidianus
(C fiber nerve ending). The endothelin-1 peptide applied to the nasal mucosa causes
sneezing
Pruritus
• Pruritus is a condition whose mechanism is not fully known.
• Pruritus lasts mainly along the RAFC and in allergic rhinitis typically causes palatal
itching. Itching occurs when histamine binds to the H1-receptor, at the tip of the
trigeminal nerve fibers and can occur immediately after the provocation of
histamine.
Rhinnorhea
• Rhinnorhea is defined as excessive secretion of nasal mucous membrane secretion,
beginning within three minutes post-allergen reference and ending in about 20-30
minutes later.
• It is a dominant symptom throughout the RAFC but can also be as long as RAFL. The
secretion of the gland is due to the arousal of the parasympathetic nerves and the
flow of plasma fluids and large protein molecules through the capillary walls of the
nasal blood vessels.
Nasal congestion
• nasal congestion in allergic rhinitis is a non-sedentary airway congestion, but occurs
temporally due to temporary congestion of vascular vasodilation.
• This vasodilation mechanism is mediated by the H1-receptor, which results in the
widening of the cavernous venous sinusoid in the conjugate mucosa, resulting in an
increase in air resistance in the nose.
• Doses of secretions in the nose also add to the nasal obstruction.
ANTIGEN
• Satu macam alergen dapat merangsang lebih dari satu organ sasaran, sehingga
memberi gejala campuran, misalnya debu rumah yang memberi gejala asma bronkial
dan rinitis alergi. Dengan masuknya antigen asing kedalam tubuh, terjadi reaksi yang
secara garis besar terdiri dari :
• Primary respons
• Secondary respons
• Tertiary respons
ANTIGEN
• An allergen can stimulate more than one target organ, thus giving mixed symptoms,
such as dust that gives symptoms of bronchial asthma and allergic rhinitis. With the
entry of foreign antigens into the body, there is a reaction that outline consists of:
• Primary respons
• Secondary respons
• Tertiary respons
• Primary respons
• There is a process of elimination and phagocytosis of the antigen (Ag). This reaction is
nonspecific and may end here. When Ag is unsuccessful entirely removed, the reaction
continues into a secondary response
• Secondary respons
• The reaction that occurs is specific, which has 3 possibilities is the cellular or humoral
immune system or both are raised. If Ag is successfully eliminated at this stage, the
reaction is complete. If Ag is still present or there is a defect from the immunological
system, then the reaction continues into the tertiary response
• Tertiary respons
• The immunological reaction does not benefit the body. This reaction may be temporary or
permanent depending on the elimination of Ag by the body