Management of Chronic

pansinusitis and nasal

polyposis with functional
endoscopy sinus surgery
by. Fauziah Henny

ENT Department of dr. Pirngadi General Hospital

Medan
2017
Rhinosinusitis

Rhinosinusitis the inflammation of Nasal and sinus mucosa.

Acute Rhinosinusitis inflammation of nasal and sinus mucosa less
than 4 weeks.
Chronic rhinosinusitis the inflammation of nasal and sinus mucosa
for more than 12 weeks.
Chronic Pansinusitis all of sinuses are infected for more than 12
weeks.
Chronic Rhinosinusitis with polyp chronic rhinosinusitis with
evidence of unilateral or bilateral polyp in the inferior, medial and
superior meatus.
Etiology
Exciting Causes
Nasal Infection
swimming and Diving
Trauma
Dental Infection
Predisposing causes
Obstruction to sinus ventilation and drainage, due to:
Nasal Packing
Deviated Septum
Hyperthropic Turbinate
Oedema of sinuss sosstia due to allergy or vasomotor rhinitis
Nasal polyp
Structural abnormality of ethmoidal air cell
Benign or malignant neoplasma
Stasis of secretion in the nasal cavity
Previous attack of sinusitis
General
Environment
Poor general Health
Patophisiology of Chronic Sinusitis
Pollution, Chemicals,
Infections

Loss of cillia
Polipy,
DNS,
Adenoi
Impaired Mucosal Changes Allergy
d
Drainage
Tumour
,
Allergy
Infections

Inadequat therapy of acute

Sinusitis
 Symptoms of Rhinosinusitis
Major symptoms :
Nasal Discharge purulent discharged anterior or posterior nasal discharge
Nasal Congestion or Obstruction
Facial Congestion or fullnesss
Facial Pain or presssure or fullnes
Olfactory disturbance
Minor Symptoms :
Headache
Chronic Unproductive cough
Ear pain or pressure or fullness
Halitosis fetid breath unpleasant taste
Dental pain
Fatigue
fever
Treatments

Medical treatments.
To avoid the allergyc factors
Topical nasal glucocorticosteroid
Oral antihistamine
Decongestants
Broad Spectrum antibiotics

Surgery
FESS
case
Januari 12th, 2017, A 16 years old Girl come to ENT Department dr.
Pirngadi General Hospital Medan with the complaint of nasal stuffines.
The nasal stuffiness had occured for 5 years. The patients also
complain of facial pain, purulent nasal discharge,foul smelling nasal
discharge and headache . there is a history of allergy that signed with
the complaint of sneezing almost every morning and the patients had
undertaken the allergy test from another hospital while the result is
unclear. On Physical Examination, The polip nasal can be seen with the
anterior rhinoscopy from both nasal cavity ,There is The nasal Purulent
discharge can be seen at the wall of pahrynx. No Caries dentist from
inspection from oral Cavity
The doctor planned to performed nasoendoscopy and CT scan of Sinus.
In The nasoendoscopy viewed polyp formation and nasal discharge at
both of the Medial turbinate. In the Ct Scan Sinus the doctor viewed
the picture of pansinusitis.
The patient treated with corticosteroid nasal spray, antibiotic,
analgetic and anti histamin. All of therapies was given 2 weeks before
the functional endoscopy sinus surgery (FESS) was perfomed.
Nasoendoscopy

Polyp
CT scan
Frontalis Sinusitis
CT Scan

Sinusitis Maksilaris/ polip antrokoanal

CT Scan

Sinusitis Ethmoidalis
CT Scan

Sinusitis Sphenoidalis
FESS

Procedure surgical that was done for this

case :
1. Polipectomy
2. Unsinectomy
3. Ethmoidectomy
4. Frontectomy
5. sphenoidectomy
Insertion adrenalin tampon to cavum
nasi
Polyp Removal
unsinectomy
ethmoidectomy
Frontectomy
Discussion

In this case the cause of pansinusitis with nasal polyposis is the long
time nasal and sinus mucous inflammation due to the uncontrol
allergy and not treated adequately. The patient have complained of
nasal congestion for 5 years and there is a history of allergy. What is
the allergen for the patients is unclear.
After the patient treated with corticosteroid nasal spray,
antihistamin, analgetic and broad spetrum antibiotics for 2 weeks, no
ssignificant changing with the complain of the patient. Therefor, the
doctor decide to perform FESS for this patient.
The procedure that was done in FESS are polipectomy, unsinectomy
bilateral, ethmoidectomi bilateral, frontectomy bilateral and
sphenoidectomy bilateral.
Discussion

Surgery is the treatment of choice in Chronic Rhinosinusitis in the

presence of massive panpolyposis and/or when efforts of conservative
treatment after individual etiological evaluation have failed or only
gone along with partial or temporary relief. In such situations
endonasal sinus surgery is the gold standard of therapy as a relative
indication. (Jan Gosepath and Wolf J. Mann 2005)
After FESS, the patient treat with corticosteroid nasal spray, antibiotic
and antihistamin oral. And the patient suggest to do nasal washing 2
times a day.
The observation post FESS have still done until this case is presented.