Diseases of PNS
A patient with sinus infection develops chemosis, B/L proptosis and fever, the diagnosis goes in favor of: [AIIMS May 2011]
|A||Lateral sinus thrombosis|
|B||Frontal lobe abscess|
|C||Cavernous sinus thrombosis|
Cavernous sinus thrombosis is a complication of orbital cellulites (As explanation in Ans. 18)
Cavernous SINUS INFECTION Route of Spread
a. Ethmoid sinus (most common) via ophthalmic veins
b. Sphenoid sinus by direct spread.
c. Frontal sinus via supraorbital and ophthalmic veins.
d. Orbit by ophthalmic veins.
e. Upper lidvia Angular vein and ophthalmic veins.
f. Ear by petrosal venous sinuses.
a. Onset is abrupt with fever, chills and rigor
b. It is bilateral
c. Involvement of IlIrd, IVth, Vth and Vlth cranial nerves
d. Chemosis of conjunctiva
e. Proptosis of the eye with limited movements
g. Pupils are dilated and fixed
h. Decreased vision
i. Decreased sensation in distribution ofVth.nerve (ophthalmic division)
j. Progressive ophthalmoplegia (specially for lateral gaze)
It is a life-threatening condition. Antibiotics are given in high doses for 4-6 weeks.
a. The incidence of all orbital complications including cavernous sinus thrombosis are common in pediatric age group.
b. Visual problems are present from stage III onward of orbital cellulitis . from stage of abscess formation.
c. Orbital complications are almost always secondary to ethmoid rhinosinusitis but may occur with frontal rhinosinusitis also.