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Supervisor :
dr. Oscar Djauhari, Sp.THT-KL
Presentator :
Belinda Anabel (2015.061.002)
CASE DISCUSSION
25yo, has been having toothache for 2
CASE DISCUSSION
A. PATIENTS IDENTITY
Name
:T
Gender : Female
Age
: 20 years old
Occupation : Employee
Address : Cikole
CASE DISCUSSION
Chief Complaint : yellowish stinky-odor discharge from her left nose
Additional Complaint : Fullness and difficulty in breathing and smelling of the left nose
History of Present Illness
The patient came to the hospital with complaints of yellowish stinky odor discharge
from her left nose. The discharge is not massive, but it smells bad. She felt this since
3 weeks before admission, she also feels that the discharge is flowing down from her
nose to her throat without intending to.
She had a fever about 2 weeks before admission, followed with dull pain on her right
face and head and radiates to the teeth. There was also profuse nasal discharge at
that time. Currently, the patient also complains of fullness and difficulty in breathing
and smelling from her left nose. She has been feeling this since 2 weeks before
admission.
The patient admits she had been having a toothache on her left molar tooth since 2
years ago. She denies the presence of allergy, sneezing, itching of the nose, recent
common cold or cough, trauma on the nose, and infection of the upper respiratory
tract. She also denies the presence of previous blood discharge or pain from her
nose, history of currently tooth removal, tootache, and inserting something into her
nose. The presence of hearing dysfunction, fullness in the ear or any discharge from
the ear is denied.
Currently, she is not taking any medication.
CASE DISCUSSION
History of Past Illness
CASE DISCUSSION
C. PHYSICAL EXAMINATION
General condition : Moderately ill
Body weight
: 50 kg
Height
: 155 cm
Blood pressure : 110/70 mmHg
Pulse
: 80 beat per minute
Respiratory rate : 24 times per minute
Temperature
: 36,3oC
CASE DISCUSSION
ENT Examination
Ear
Right ear
CASE DISCUSSION
Nose
Right nose
Mucous membrane: hyperemic(-), edema(-), secretion(-), crust(-),
mass(-).
Conchae : hypertrophic(-), hyperemic(-), meatus secrete(-)
Septum : no deviation
Air passage: normal
Left nose
CASE DISCUSSION
Oropharynx
zygomatic bone
Neck
WORKING DIAGNOSIS
Acute rhinosinusitis maxillaris unilateral et
causa odontogenic.
WORK-UP
Transillumination test
Radiologic examination : plain film x-ray of
TREATMENT
Outpatient care
Refer to dentist for tooth extraction
Antibiotic : Co-amoxiclav 3 x 625 mg PO for
7 days
Decongestant : Pseudoephedrine HCl
120mg 2x1 tab
DEFINITION
Rhinosinusitis comprises a spectrum of
ANATOMY
PARANASAL SINUSES
- air space within certain bones of the skull
- decrease skull bone weight, sound resonance
- consist of : frontal, ethmoidal, sphenoidal, maxillary
ANATOMY
Maxillary Sinuses
the largest
behind the cheekbone, extending from just
ANATOMY
Frontal Sinuses
above
ANATOMY
Ethmoidal Sinuses
behind the eyes and behind the bridge of
the nose
consists of seven to fifteen chambers
the anterior, drains into middle nasal
meatus
the posterior, drains into superior nasal
meatus
ANATOMY
Sphenoidal Sinuses
behind the nose, behind the eyes and at
ETIOLOGY
Aerobic Bacteria
Anaerobic bacteria
Streptoccocus Pneumonia
Peptostreptococcus
Haemophilus Influenzae
Bacteroides spp.
Streptococcus Group A
Fusobacteria
Moraxella Catarrhalis
Pseudomonas sp.
Klebsiella sp.
PATHOPHYSIOLOGY
Chronic sinusitis infection is usually
PATHOPHYSIOLOGY
The origin of the maxillary sinusitis may be
PATHOPHYSIOLOGY
Rhinogen
PREDISPOSITION FACTOR
Genetic/ physiological factor
-Airway hyperreactivity
-Immunodeficiency
-Aspirin sensitivity
-Ciliary dysfunction
-Cystic fibrosis
-Autoimmune disease
-Granulomatous disorders
PREDISPOSITION FACTOR
Environmental factor:
-Allergy
-Smoking
-Irritants, pollutions
-Virus
-Bactery
-Fungi
-Stress
PREDISPOSITION FACTOR
Structural factor
-septum deviation
-concha bullosa
-bone inflammation
-foreign body
-tooth disease
-haller cells
-frontal cells
-anomali craniofacial
-mechanical trauma
-barotrauma
-paradoxic middle
turbinates
CLINICAL MANIFESTATION
Complaint of post nasal drip, nasal discharge
DIAGNOSTIC CRITERIA
Major
Minor
Facial pain/pressure
Nasal obstruction
Nasal discharge/discolored
postnasal drip
Headache
Fever (all nonacute)
Halitosis
Dental pain
Hyposmia/anosmia
Fatigue
Purulence in examination
Cough
Ear pain/pressure/fullness
DIAGNOSIS
Diagnosis of chronic sinusitis can be made with
DIAGNOSIS
The infundibular pattern (obstruction in the
COMPLICATION
Orbital Cellulitis
COMPLICATION
Mucocele
THERAPY
Dentogene Sinusitis should be treat by
THANK YOU