Учебники / Pediatric Sinusitis and Sinus Surgery Younis 2006
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Preface
Sinusitis is a common disease entity in the pediatric and adult age groups. Pediatric sinusitis is a dynamic complex entity manifesting itself with a variety of signs and symptoms that may be compounded by a multitude of comorbidities. The etiological factors may vary from the most common upper respiratory tract infections and allergy to unusual systemic genetic disorders, such as cystic fibrosis or immune deficiency. The diagnosis and management of pediatric sinusitis requires meticulous attention to details.
Pediatric patients are not young adults; many etiological and inherent factors of pediatric sinusitis may not apply to adults. Even in the pediatric age group, younger patients should be addressed and treated differently than older and adolescent children. Sinusitis may be confused in pre- school-age children more than in adolescents, and adults. In this age group, it may be difficult to differentiate upper respiratory tract infections from allergy or what is commonly known as ‘‘day care syndrome,’’ yet these latter factors can easily lead to sinusitis. Additionally, adenoiditis or adenoidal hypertrophy may mimic or cause sinusitis; however, the perspective and management may be similar. Furthermore, whenever treating pediatric sinusitis, our attention should not just be concentrated on sinuses as a variety of other contributing factors should be identified and controlled. These can include, but not be limited to, gastroesophageal reflux, allergy, cystic fibrosis, and immotile cilia syndrome.
In the past, pediatric sinusitis may have been poorly recognized and understood. Currently we face the problem of overdiagnosis and treatment. This is why we need to exhaust our efforts in isolating any ‘‘contributory’’ or etiological factors prior to labeling or treating a child. Diagnosis in children
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is challenging because we are commonly dealing with a sick, nervous, apprehendive child who is difficult to examine. Moreover, the history is given by parents or caretakers who have their own perspectives and expectations of the child.
The mainstay of therapy is medical treatment, with antibiotics and nasal steroid spray being the cornerstones. A wide variety of surgical procedures have been discussed. Pediatric endoscopic sinus surgery has become the surgical procedure of choice since its introduction in the late 1980s. It had evolved over the years to include additional instrumentation and applications with extremely rewarding and successful results; yet standardized outcomes are not well identified.
In this textbook, the various aspects of pediatric sinusitis are addressed in detail. It is a unique book that covers pediatric sinusitis and sinus surgery in a comprehensive and explicit fashion. The uniqueness of this work is that it comprises a spectrum of factors manifested by scientifically sound subject matter and easy flow of information. It is meticulously tailored and written by world-renowned experts in the field. This book is not directed only to otolaryngologists, but also to medical students, pediatric or primary care residents, and paramedical specialists.
The chapters are easy to read with a wealth of information that is easily accessible. All pertinent aspects of pediatric sinus diseases are discussed. Embryology, anatomy, and physiology along with detailed diagnostic work-up are discussed in the first chapters to allow the reader to understand and visualize a clear image of the sinusitis in children. The complications of sinusitis that are most common in children are then detailed, along with an additional chapter comparing adult versus pediatric sinusitis. Several factors may affect sinusitis in children; hence, each and every factor is critical and has been explicitly detailed in four other chapters that include pediatric sinusitis and comorbidities, allergy, immune deficiency, and cystic fibrosis. Surgical and medical management are dealt with at length in two other chapters. Emphasis is further made on the delicate and critical role of endoscopic sinus surgery by detailing the various aspects of pediatric endoscopic sinus surgery. Additional chapters that discuss the role of computer-assisted surgery and new stepwise approaches to endoscopic sinus surgery, along with another chapter on the importance of sphenoid sinus and complications of endoscopic sinus surgery are provided. The critical role of tonsils and adenoids in sinusitis in children is also very well elicited. In addition to all these important features, we felt it prudent to give advice it on how to set up and establish a successful and productive sinus center in the final chapter.
This textbook has been adequately structured to cover the wide spectrum of sinusitis in children. The content and scope are written to appeal to various subspecialists involved in the management of pediatric sinusitis. This may include pediatricians, immunologists, allergists, infectious disease
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specialists, intensivists, pulmunologists, and otolaryngologists. The complex and delicate nature of pediatric sinusitis dictates the need of teamwork of specialists along with caretakers. The importance and necessity of multispecialty efforts to tackle sinusitis in children are well portrayed. The chapters are elegantly written in a resourceful and scientific fashion. The uniqueness and universality of this textbook had been unseen earlier. Finally, I would like to thank my publisher for helping me to get this dream into factual reality with special recognition and thanks to my valuable authors. I would like also to extend my sincere and warmest appreciation to my wife and children who have endured tirelessly with me to produce this magnificent book.
Ramzi T. Younis
Contents
Foreword |
Thomas J. Balkany |
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Foreword |
Charles Gross . . . . |
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Foreword |
K. J. Lee . . . . ix |
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Preface . . . . xi |
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Contributors |
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1.Embryology and Anatomy of the Nose
and Paranasal Sinuses . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Raphael Chan, Frank C. Astor, and Ramzi T. Younis
Embryology of the Nose . . . . 1
The Developmental Anatomy of the Lateral Nasal Wall . . . . 3
The Ethmoid Sinus . . . . 5 References . . . . 13
2.Pathophysiology and Etiology of Pediatric Rhinosinusitis . . 15
Melissa A. M. Hertler, Ron B. Mitchell, and Rande H. Lazar
Introduction . . . . 15 Pathophysiology . . . . 17 Etiology . . . . 18 Conclusion . . . . 25 References . . . . 26
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Diagnostic Workup for Pediatric Rhinosinusitis . . . . . . . . |
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Edward Hepworth and Ron B. Mitchell |
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Introduction . . . . |
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Developmental Anatomy as Relevant to |
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Disease Workup |
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Disease History . . . . |
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Review of Systems |
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Physical Examination . . . . |
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Other Clinical and Laboratory Investigations . . . . 39 |
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Radiographic Evaluation . . . . |
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Other Tests . . . . |
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Other Diagnostic Considerations |
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Natural History of Disease |
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Summary . . . . |
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References . . . . |
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Adult Versus Pediatric Sinusitis |
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Raphael Chan, Frank C. Astor, and Ramzi T. Younis |
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Introduction . . . . |
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Anatomy . . . . |
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Pathophysiology |
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Microbiology . . . . |
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The Clinical Diagnosis of Sinusitis . . . . |
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Diagnostic Aids . . . . |
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Complications . . . . |
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Treatment . . . . |
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Conclusion . . . . |
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5.Complications of Pediatric Sinusitis . . . . . . . . . . . . . . . . . 65
Kevin D. Pereira, Tina P. Elkins, and Ramzi T. Younis
Introduction . . . . 65 Mucoceles . . . . 67 Osteomyelitis . . . . 67 Orbital Cellulitis . . . . 68 Preseptal Cellulitis . . . . 68
Postseptal Inflammation . . . . 69 Cavernous Sinus Thrombosis . . . . 71 Intracranial Complications . . . . 71 Subdural Empyema . . . . 72
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Intracerebral Abscess . . . . 72
Epidural Abscess . . . . 73
Meningitis . . . . 74
References . . . . 75
6.Pediatric Sinusitis and Comorbidities . . . . . . . . . . . . . . . . 77
Maria T. Pen˜a and George H. Zalzal
Introduction . . . . 77 Allergic Rhinitis . . . . 78 Asthma . . . . 81
Cystic Fibrosis . . . . 83 Gastroesophageal Reflux Disease . . . . 86 Immune Dysfunction . . . . 88
Primary Ciliary Dyskinesia . . . . 90 Otitis Media . . . . 92
References . . . . 94
7. Pediatric Allergy and Sinusitis . . . . . . . . . . . . . . . . . . . . |
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Samantha M. Mucha and Fuad M. Baroody |
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Introduction . . . . 99 |
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Pathophysiology |
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Summary . . . . |
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References . . . . |
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8.Immune Deficiency/Disorders and Pediatric Sinusitis . . . . 113
Gary Kleiner
Introduction . . . . 113
Primary Immune Deficiencies Associated with Sinusitis . . . . 116
References . . . . 121
9.Cystic Fibrosis and Sinusitis . . . . . . . . . . . . . . . . . . . . . 123
Craig S. Derkay and Scott A. Schraff
Introduction . . . . 123 Epidemiology and Genetics . . . . 124 Pathophysiology . . . . 125
Clinical Manifestations . . . . 127 Diagnosis . . . . 129
Medical Management . . . . 129 Surgical Management . . . . 131
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Conclusions . . . . |
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10. Medical Treatment of Rhinosinusitis in |
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Infants and Children |
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Joshua A. Gottschall and Michael S. Benninger |
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Introduction . . . . |
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Definitions . . . . |
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Clinical Presentation and Diagnosis . . . . |
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Causative Factors and Associated Illnesses |
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Treatment Overview |
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Microbiology of Acute and Chronic Rhinosinusitis . . . . |
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Antimicrobial Management of Rhinosinusitis . . . . 151 |
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Adjuvant Therapies |
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When Do We Operate? . . . . 158 |
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Conclusion . . . . |
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References . . . . |
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11.Pediatric Endoscopic Sinus Surgery . . . . . . . . . . . . . . . . 163
Ramzi T. Younis
Introduction . . . . 163
Pediatric Rhinosinusitis . . . . 164 Diagnosis of Rhinosinusitis . . . . 167 Radiologic Findings . . . . 170 Treatment . . . . 172
Surgical Management . . . . 173 Adenoidectomy . . . . 173 Other Considerations . . . . 174
Pediatric Endoscopic Sinus Surgery . . . . 174 Technique and Instrumentation . . . . 175 Outcomes and Pitfalls . . . . 179
Conclusion . . . . 180 References . . . . 181
12.Image-Guided Pediatric Sinus Surgery . . . . . . . . . . . . . . 187
Sam J. Daniel
Introduction . . . . 187 Technology . . . . 188
Use of IGS in Pediatric Otolaryngology . . . . 191 Limitations of Image-Guided Surgery . . . . 196
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Conclusion . . . . 197
References . . . . 198
13.A Step-Wise Approach to Endoscopic Surgery for Advanced Sinonasal Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201
Roy R. Casiano
Introduction . . . . 201 Conclusions . . . . 213 References . . . . 214
14.Role of Tonsils and Adenoids in
Pediatric Sinusitis . . . . . . . . . |
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Hassan H. Ramadan |
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Adenoids and Sinusitis . . . . |
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Adenoid Size and Sinusitis . . . . |
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Adenoiditis and Sinusitis . . . . |
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Adenoidectomy and Sinusits . . . . |
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References . . . . 221 |
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15.Complications of Sphenoid Sinus Surgery . . . . . . . . . . . . 225
Sarita Kaza and Ramzi T. Younis
Introduction to Sphenoid Surgery . . . . 225 Anatomy . . . . 226
Anatomic Variations . . . . 226 Presentation/Pathophysiology . . . . 227 Complications and Management . . . . 227 Endoscopic Surgical Approaches . . . . 230 Application of Image-Guided Surgery . . . . 231 Conclusion . . . . 232
References . . . . 232
16. How to Set Up a Sinus Center . . . . . . . . . . . . . . . . . . . 235
Michael Setzen, Gavin Setzen, and Mary LeGrand
Introduction . . . . 235
Organizational Considerations . . . . 236 Telephone Triage . . . . 238 Embryology of a Sinus Center . . . . 239
Reimbursement and Insurance Issues . . . . 242 Correct Coding . . . . 244
Coding Office-Based Procedures . . . . 245