Sinusitis..

(1)

SINUSITIS

Dr.Susilaningrum Sp.THT

Departemen THT

RSPAD Gatot Soebroto

(2)

PENDAHULUAN

SINUS PARANASAL :



_{SINUS MAKSILARIS}



_{SINUS R!NTALIS}



_{SINUS "TM!IDALIS}



(3)

SINUS PARANASAL



_{Empat sinus}

(4)

ANATOMI SINUS PARANASAL

SINUS MAKSILARIS

 _{SINUS TERBESAR VOL 6-8 ml (lahir}_{SINUS TERBESAR VOL 6-8 ml (lahir} ___{!" ml (#$%asa}_{!" ml (#$%asa}

POSTERIOR && IN'RATE)PORAL )ASILAIN'RATE)PORAL )ASILA )EDIAL

)EDIAL && LATERAL RON**A HIDUN*LATERAL RON**A HIDUN* SUPERIOR

SUPERIOR && DASAR ORBITADASAR ORBITA IN'ERIOR

IN'ERIOR && PROSESUS ALVEOLARIS + PALATU)PROSESUS ALVEOLARIS + PALATU) DASAR SINUS )ASILA & P!+P, )!+), ./)/

DASAR SINUS )ASILA & P!+P, )!+), ./)/ Ost$um sinus ma0sila l$1ih tin22i #ari #asar sinus

Ost$um sinus ma0sila l$1ih tin22i #ari #asar sinus _

SINUSITIS SINUSITIS

(5)

SINUS R!NTAL

 P$r0$m1an2an pa#a usia 8-!3 th ma4 ,3 th_{P$r0$m1an2an pa#a usia 8-!3 th ma4 ,3 th}

 Ti#a0 sim$tris 0a#an2 ti#a0 1$r0$m1an2 0a#an2_{Ti#a0 sim$tris 0a#an2 ti#a0 1$r0$m1an2 0a#an2} ! sinus

! sinus

 Tin22i ,8 5m l$1ar , 5m #alam , 5m_{Tin22i ,8 5m l$1ar , 5m #alam , 5m}

 B$rs$0at t$pi sinus 1$rl$0u0-l$0u0_{B$rs$0at t$pi sinus 1$rl$0u0-l$0u0}

 Dipisah0an 7l$h tulan2 an2 tipis #ari 7r1ita #an_{Dipisah0an 7l$h tulan2 an2 tipis #ari 7r1ita #an} 97sa s$r$1ri ant$ri7r

97sa s$r$1ri ant$ri7r _in9$0siin9$0si

 Dr$nas$ m$lalui 7st$um 2 t$rl$ta0 #i r$s$sus_{Dr$nas$ m$lalui 7st$um 2 t$rl$ta0 #i r$s$sus} 9r7ntalis (1a2ian #ari sinus $tm7i# ant$ri7r

(6)

SINUS "TM!ID

 Ba2ian p$ntin2_{Ba2ian p$ntin2} __970us in9$0si sinus lainna970us in9$0si sinus lainna

 B$ntu0 s$p$rti pirami# #asarna #i1a2ian_{B$ntu0 s$p$rti pirami# #asarna #i1a2ian} p7st$ri7r

p7st$ri7r

 U0uran ant-p7st -" 5m tin22i , 5m l$1ar 3"_{U0uran ant-p7st -" 5m tin22i , 5m l$1ar 3"} 5m #i 1a2 ant$ri7r #an !" 5m #i 1a2 p7st$ri7r 5m #i 1a2 ant$ri7r #an !" 5m #i 1a2 p7st$ri7r

 B$r7n22a-r7n22a s$p$rti saran2 ta%7n (-!: s$l_{B$r7n22a-r7n22a s$p$rti saran2 ta%7n (-!: s$l}

(7)

SINUS "TM!ID

 )uara sinus $tm7i# ant$ri7r & m$atus m$#_{)uara sinus $tm7i# ant$ri7r & m$atus m$#}

 )uara sinus $tm7i# p7st$ri7r & m$atus sup_{)uara sinus $tm7i# p7st$ri7r & m$atus sup}

 S$l $tm7i# ant$ri7r 0$5il, + 1ana0_{S$l $tm7i# ant$ri7r 0$5il, + 1ana0}

 S$l $tm7i# p7st$ri7r l$1ih 1$sar + s$#i0it_{S$l $tm7i# p7st$ri7r l$1ih 1$sar + s$#i0it}

 S$l $tm7i# t$r1$sar & 1ula $tm7i#_{S$l $tm7i# t$r1$sar & 1ula $tm7i#}

 P$n$mpitan #i $tm7i# ant$ri7r & in9un#i1ulum_{P$n$mpitan #i $tm7i# ant$ri7r & in9un#i1ulum} (t$mpat muara sinus ma0sila

(t$mpat muara sinus ma0sila

 Atap $tm7i# & 97;$a $tm7i#alis (lamina 0ri1r7sa_{Atap $tm7i# & 97;$a $tm7i#alis (lamina 0ri1r7sa}

 Din#in2 lat$ral & lamina papiras$a_{Din#in2 lat$ral & lamina papiras$a}

(8)

SINUS S"N!ID

 Di1$la0an2 sinus $tm7i# p7st$ri7r _{Di1$la0an2 sinus $tm7i# p7st$ri7r}

 Di1a2i 7l$h , s$0at & s$ptum int$rs9$n7i#_{Di1a2i 7l$h , s$0at & s$ptum int$rs9$n7i#}

 Tin22i , 5m #alam ,/ 5m l$1ar !:5m ;7lum$ "-_{Tin22i , 5m #alam ,/ 5m l$1ar !:5m ;7lum$} "-:" ml

:" ml

 Sup$ri7r & 97sa s$r$1ri m$#ia + 0$l< hip79isa_{Sup$ri7r & 97sa s$r$1ri m$#ia + 0$l< hip79isa}

 In9$ri7r & atap nas79arin2_{In9$ri7r & atap nas79arin2}

 Lat$ral & sinus 0a;$rn7sus + a=0ar7tis int$rna_{Lat$ral & sinus 0a;$rn7sus + a=0ar7tis int$rna}

(9)

UNGSI SINUS PARANASAL



_{)$n2atur 07n#isi u#ara}



P$nahan suhu

_{P$nahan suhu}



)$m1antu 0$s$im1an2an 0$pala

_{)$m1antu 0$s$im1an2an 0$pala}



)$m1antu r$s7nansi suara

_{)$m1antu r$s7nansi suara}



P$r$#am p$ru1ahan t$0anan u#ara

_{P$r$#am p$ru1ahan t$0anan u#ara}



_{)$m1antu pr7#u0si mu0us untu0}

m$m1$rsih0an r7n22a hi#un2

(10)

P"M"RIKSAAN SINUS

PARANASAL

!=

!= Insp$0si

Insp$0si

,=

,= Palpasi

Palpasi

/=

/= Rin7s07pi ant$ri7r

Rin7s07pi ant$ri7r

=

= Rin7s07pi p7st$ri7r

Rin7s07pi p7st$ri7r

"=

"= Transiluminasi

Transiluminasi

6=

6= P$m$ri0saan ra#i7l72i0

P$m$ri0saan ra#i7l72i0

:=

(11)

SINUSITIS MAKSILARIS

(12)

SINUS MAKSILARIS SERING

TERINFEKSI , KARENA :

 SINUS PARANASAL TERBESAR_{SINUS PARANASAL TERBESAR}

 _{LETA OSTIU) LEBIH TIN**I DARI DASAR}_{LETA OSTIU) LEBIH TIN**I DARI DASAR}  OSTIU) TERLETA DI )EATUS )EDIUS DI_{OSTIU) TERLETA DI )EATUS )EDIUS DI}

SEITAR HIATUS SE)ILUNARIS >AN* SEITAR HIATUS SE)ILUNARIS >AN*

SE)PIT SE)PIT

(13)

DE'INISI

SINUSITIS MAKSILARIS

RADAN* )UOSA SINUS

)ASILARIS

(14)

'ATOR PREDISPOSISI &

 OBSTRUSI )EANI_{OBSTRUSI )EANI}

 POST PE)ASAN*AN TA)PON_{POST PE)ASAN*AN TA)PON}

 'RATUR ?A@AH_{'RATUR ?A@AH}

 BAROTRAU)A_BAROTRAU)A

 LIN*UN*AN_LIN*UN*AN _ POLUSI UDARA DIN*INPOLUSI UDARA DIN*IN DAN ERIN*

DAN ERIN*

 RINISTIS RONIS RINITIS ALER*I_{RINISTIS RONIS RINITIS ALER*I}

 _{PEN>AIT SISTE)I}_{PEN>AIT SISTE)I}  PEN>AIT *I*I *ELI*I_{PEN>AIT *I*I *ELI*I}

(15)

ETIOLOGI ETIOLOGI

!=

!= VIRUSVIRUS

PADA IN'ESI SALURAN NAPAS ATAS PADA IN'ESI SALURAN NAPAS ATAS ,=

,= BATERIBATERI

- STREPTO.O..US PNEU)ONIAE- STREPTO.O..US PNEU)ONIAE - HAE)OPHILLUS IN'LUENAE- HAE)OPHILLUS IN'LUENAE

- STAPH>LO.O..US AUREUS - STAPH>LO.O..US AUREUS

(16)

PATO'ISIOLO*I

EDE)A O)

EDE)A O) _ SILIA TIDA BER*ERASILIA TIDA BER*ERA _ LENDIRLENDIR TIDA DAPAT DIALIRAN

TIDA DAPAT DIALIRAN _ *AN**UAN DRAINASE*AN**UAN DRAINASE DAN VENTILASI

DAN VENTILASI _ SILIA INATI' LENDIR ENTALSILIA INATI' LENDIR ENTAL ()EDIA >AN* BAI UNTU TU)BUHN>A BATERI ()EDIA >AN* BAI UNTU TU)BUHN>A BATERI PATO*EN

PATO*EN

BILA BERLAN*SUN* TERUS

BILA BERLAN*SUN* TERUS _ HIPOSIA +HIPOSIA + RETENSI LENDIR

RETENSI LENDIR _ IN'ESI OLEH BATERIIN'ESI OLEH BATERI ANAEROB

ANAEROB _ PERUBAHAN @ARIN*ANPERUBAHAN @ARIN*AN _

HIPERTRO'I POLIPOID HIPERTRO'I POLIPOID

(17)

LASI'IASI SINUSITIS

B$r#asar0an %a0tu &

!=

!= Sinusitis A0ut

Sinusitis A0ut

,=

,= Sinusitis Su1a0ut

Sinusitis Su1a0ut

/=

(18)

)ANI'ESTASI LINIS

Su1<$0ti9

Su1 <$0ti9

!=

!= Sinusitis A0ut

Sinusitis A0ut

D$mam malais$ n$ri 0$pala %a<ah

1$n20a0 t$rasa p$nuh n$ri pipi tumpul

#an m$nusu0 2i2i t$rasa n$ri

,=Sinusitis Su1a0ut

*$<ala  a0ut tan#a ra#an2 (-

(19)

/= Sinusitis r7nis

*$<ala )a7r *$ <ala )a7r

 _{?a<ah t$rasa n$riC}_{?a<ah t$rasa n$riC}

t$rt$0an t$rt$0an

 ?a<ah t$rasa p$nuh_{?a<ah t$rasa p$nuh}

 O1stru0si nasal_{O1stru0si nasal}

 In2us 1$rnanah C p7st_{In2us 1$rnanah C p7st} nasal #rip

nasal #rip

 _{Hip7smia C an7smia}_{Hip7smia C an7smia}

*$<ala )in7r *$ <ala )in7r

 _{Sa0it 0$pala}_{Sa0it 0$pala}  _D$mam_D$mam

 _Halit7sis_Halit7sis  _$l$tihan_$l$tihan  _{N$ri 2i2i}_{N$ri 2i2i}  _Batu0_Batu0

 _{N$ri t$lin2aC t$rasa}_{N$ri t$lin2aC t$rasa}

p$nuh t$rt$0an p$nuh t$rt$0an

(20)

B$r#asar0an 0rit$ria

B$r#asar0an 0rit$ria International on

International on

Sinus Disease

Sinus Disease tahun !/

tahun !/

Dia2n7sa Sinusitis &



_{, 2$<ala ma7r atau}

, 2$<ala ma7r atau

(21)

OB@ETI'

!=Sinusitis A0ut !=Sinusitis A0ut

- Rin7s0= Ant

- Rin7s0= Ant _ Pus #alam hi#un2Pus #alam hi#un2 - Rin7s0= P7st

- Rin7s0= P7st _ S$0r$t mu07purul$n #alam nas79arin2S$0r$t mu07purul$n #alam nas79arin2 - Sinus ma0silaris t$rasa n$ri pa#a palpasi #an p$r0usi - Sinus ma0silaris t$rasa n$ri pa#a palpasi #an p$r0usi

,= Sinusitis Su1a0ut ,= Sinusitis Su1a0ut

- Sama #$n2an sinusitis a0ut - Sama #$n2an sinusitis a0ut

/= Sinusitis r7ni0 /= Sinusitis r7ni0

- Pa#a p$m$ri0saan 0linis ti#a0 s$1$rat sinusitis a0ut - Pa#a p$m$ri0saan 0linis ti#a0 s$1$rat sinusitis a0ut

- Ti#a0 t$r#apat p$m1$n20a0an %a<ah - Ti#a0 t$r#apat p$m1$n20a0an %a<ah

- Rin7s07pi ant$-p7st$ri7r  sinusitis a0ut - Rin7s07pi ant$-p7st$ri7r  sinusitis a0ut

(22)

PE)ERISAAN PENUN@AN* PADA

SINUSITIS MAKSILA

!= Transiluminasi != Transiluminasi ,= E;aluasi ra#i7l72is ,= E;aluasi ra#i7l72is

 Plain radiograph_{Plain radiograph}

 .T S5an_{.T S5an} __ pilihanpilihan

 )RI_)RI /=

/= Sinus punctureSinus puncture = US*

= US* "=

(23)

PENATALASANAAN

Sinusitis A0ut



Anti1i7ti0 sp$0trum luas

_{Anti1i7ti0 sp$0trum luas}



D$07n2$stan

_D$07n2$stan



_{Anal2$ti0 + 07mpr$s han2at pa#a %a<ah}

Bila anti1i7ti0 2a2al

_

iri2asi antrum

s$2$ra ( #apat #ila0u0an #$n2an , 5ara

(24)

Sinusitis Su1a0ut



)$#i0am$nt7sa  a0ut

_{)$#i0am$nt7sa  a0ut}



Tin#a0an & - Diat$rmi

_{Tin#a0an & - Diat$rmi}

- Pun2si #an iri2asi

- Antr7st7mi

(25)

Sinusitis r7nis



_{.ari 9a0t7r pr$#isp7sisi #an p$n$1a1}

__

t$rapi #is$suai0an



)$#i0am$nt7sa

_{)$#i0am$nt7sa}

__

anti1i7ti0 #an

#$07n2$stan



P$m1$#ahan

_P$m1$#ahan

__

Caldwell-Luc procedure



'ESS

(26)

(27)

O)PLIASI

7mpli0asi Sinusitis &



Ost$7m$litis #an a1s$s su1pp$ri7st$al

_{Ost$7m$litis #an a1s$s su1pp$ri7st$al}



$lainan 7r1ita

_{$lainan 7r1ita}



$lainan intra0ranial

_{$lainan intra0ranial}

(28)

O)PLIASI PE)BEDAHAN

'ESS&



P$rlu0aan 7r1ita

_{P$rlu0aan 7r1ita}



H$mat7m 7r1ita

_{H$mat7m 7r1ita}



$1utaan

_$1utaan



Trauma pa#a #u0tus nas7la0rimalis

_{Trauma pa#a #u0tus nas7la0rimalis}



_Epi97ra

(29)

7mpli0asi .al#%$ll-lu5 pr75$#ur$



'ist$l 7r7antral

_{'ist$l 7r7antral}

