Subtotal darkening of the maxillary sinuses. What is it, how to treat with and without liquid, horizontal, vertical level

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Green Elena Stanislavovna

Otolaryngologist of the second category

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Subtotal darkening of the maxillary sinuses - what is it and how dangerous? This conclusion can be heard in various diseases of the ENT organs. In simple terms, it is an inflammation of the mucous membrane of the maxillary sinus with accumulated secretions. An X-ray is often recommended for patients with sinusitis, sinusitis or sinusitis.

Location and functions of the maxillary sinuses

The maxillary sinus is also called the maxillary sinus. It is a paired paranasal sinus of the nasal cavity. It is located almost throughout the entire space of the maxillary bone, inside the upper jaw. The sinuses consist of the nasal, facial and orbital, posterior and inferior walls.

The maxillary sinuses are lined from the inside with a mucous membrane, which is represented by ciliated epithelium.

There are few nerves and blood vessels in this area. Therefore, inflammatory diseases of the paranasal sinuses remain undiagnosed for a long time, as they occur without severe pain. Pain usually appears during the height of the disease.

Functions of the maxillary sinuses:

• Humidification of inhaled air.
• Participation in the formation of voice.
• Regulation of intracranial pressure.
• Lightening the weight of the skull bones.
• Air filtration and protection against pathogenic microorganisms.

X-ray: where to start

During the examination, the specialist will make a preliminary diagnosis of “sinusitis” and send you for an x-ray to clarify suspicions.

An x-ray is a collection of images of the anatomical structures of the body obtained by x-ray irradiation. An X-ray image, like any negative image, consists exclusively of black and white shades. This is due to the fact that each tissue in the human body has its own degree of absorption of gamma radiation. The more tissue absorbs, the brighter and more intense it is visible in the image.

To diagnose certain diseases, it is extremely necessary to perform fluoroscopy in the optimally correct position, since only in this projection the areas required for inspection become visible. For example, there are several sinuses in the skull:

• frontal (frontal) sinus,
• wedge-shaped (main),
• maxillary (maxillary),
• lattice labyrinth.

In order for the nasal sinuses to be as visible as possible in the image, it is necessary to shoot in the following projections:

• axial – mainly used to assess the condition of the skull base, rocky part of the temporal bone and visualization of the main sinuses,
• lateral – important for examining the frontal, determining the size of the sphenoid and maxillary sinuses, the condition of the anterior parts of the facial bones and the base of the skull,
• nasofrontal – optimal for studying the frontal sinuses, cells of the ethmoidal labyrinth and orbits,
• The most clear way to trace the pneumatization of the maxillary sinus is to position the patient with the chin and nose resting on the X-ray machine stand (nasochin position).

For correct diagnosis, it is very important that the image has good contrast and sharpness and does not have any extraneous shadows or artifacts. All this together will make it much easier for the doctor to make the correct diagnosis.

To read: Death from sinusitis: myth or reality

As a rule, complete darkening of the maxillary sinuses indicates that a large amount of pus has accumulated inside them due to an extensive inflammatory process caused by harmful microorganisms.

What is called subtotal darkening of the maxillary sinuses?

Subtotal darkening of the maxillary sinuses is a radiological sign that indicates an inflammatory process in the organ. Darkening is also observed with the development of pathological changes in the mucous membrane.

Sometimes darkening may indicate the development of tumors in the sinus area. They can be either benign or malignant. The development of cysts is often detected using x-rays.

But most often, darkening on an x-ray indicates an accumulation of pus. Its detection indicates a disease such as sinusitis.

What does darkening in the lungs mean on an MRI photograph?

In images obtained using X-rays and computed tomography of the chest, darkening in the lungs means that a healthy part of the organ has been replaced by a pathological formation that displaces air with denser masses. Observed when:

Unlike the above-mentioned diagnostic methods, darkening and light areas on tomographic MR images are not associated with diseases, but with the scanning mode. In the photo, the same formations may have different colors depending on the pulse sequence used when receiving the signal.

MRI of the lungs is most informative when:

MRI of the lungs in axial projection for an abscess of the right lung (lower lobe): a – T1-weighted image; b – T2-weighted image

MRI images of the lungs visualize:

Possible causes and symptoms of blackouts in adults and children

The reasons for darkening can be very diverse.

As a rule, the following reasons are distinguished:

• Exposure to pathogenic microorganisms and the development of inflammation.
• Accumulation of pus.
• Inflammatory diseases of the paranasal sinuses.
• Sinus cysts.
• Tumors of the paranasal sinuses.
• Fluid accumulation.

Sinusitis

Subtotal darkening of the maxillary sinuses is observed with sinusitis. Sinusitis is an inflammation of the paranasal sinuses. It usually occurs against the background of long-term rhinitis or sinusitis. May have an acute or chronic course.

Symptoms of sinusitis:

• Prolonged nasal discharge, a characteristic feature of which is a change in color to greenish (purulent discharge). Possibly mixed with blood. The discharge is thick and does not drain well from the nasal cavity.
• Nasal congestion and change in sense of smell. The sense of smell decreases or disappears completely.
• Expanding headache. Localized in the frontal lobe of the skull.
• Bursting pain in the nasal sinuses, radiating to the upper jaw.
• Increased body temperature.

In children, sinusitis is more acute than in adults; a more severe fever is possible (increase in body temperature to 39-40°), intense pain in the head, and lacrimation. And also, a combination of sinusitis and otitis is often observed in young children. Inflammation of the middle ear occurs against the background of prolonged inflammation in the sinuses due to the anatomically short auditory tube in a child.

Sinusitis

Sinusitis is an inflammation of the mucous membrane of the paranasal sinuses. It can have an acute and chronic course.

The cause of sinusitis is bacterial and viral infection, incompletely treated rhinitis, and allergic reactions.

Most often, sinusitis occurs in children. This is due to the immaturity of the immune system and frequent viral diseases. In addition, sinusitis can occur in children under 1 year old, with improper rinsing of the nasal passages, as well as with excessive instillation of vasoconstrictor drops.

Sinusitis is most often acute.

You can suspect it if the following symptoms are present:

• Thick discharge from the nose, difficult to separate, yellow in color.
• Nasal congestion.
• Sore throat.
• Nasality in the voice.
• Increased body temperature.
• Headache.

  
  Pain map for acute sinusitis

Sinusitis can be suspected if rhinitis does not go away after 7-10 days.

Frontit

Frontitis is an inflammation of the frontal sinuses. The cause of inflammation is acute viral infections, complications of sinusitis, sinusitis and rhinitis. Predisposing factors may also include a deviated nasal septum, the presence of adenoids and chronic foci of infection in the body.

Inflammation develops acutely. Body temperature rises above 38.5 degrees. A pronounced pain syndrome develops in the area of ​​the brow ridges, which intensifies with pressure. There is also lacrimation, photophobia, eye pain, nasal congestion and purulent discharge from the nasal passages.

Frontal sinusitis is a serious disease that requires medical attention. With the development of this pathology, complications may develop in the form of brain damage (meningitis).

Cyst

A cyst is a round-shaped formation filled with exudate. Its detection is usually accidental, since its development is not accompanied by any pathognomonic symptoms.

Sometimes patients may complain of a foreign body sensation in the sinus area, pressure in the frontal region, fluid discharge from the nasal passages and a slight deterioration in nasal breathing.

Tumor

Tumors of the paranasal sinuses can be benign or malignant.

Malignant tumors are divided into the following types:

• Epitheliomas.
• Sarcomas.

Symptoms of tumors at the initial stage of development of the tumor process are invisible.

But as it progresses, the following clinical symptoms may appear:

• Pain in the sinus area.
• Headache.
• Enlargement of regional lymph nodes.
• Increased body temperature.
• Discharge from the nasal passages.
• Nasal congestion.

Benign tumors are also often localized in the maxillary sinuses. Their course may also be unnoticeable until the tumor reaches a large size. Typically, polyps or bone tumors that have grown from the bones of the skull into the sinus area are localized in the sinuses.

The symptoms are:

• Pain in the sinus area.
• Headache.
• Nasal congestion.
• Mucous discharge from the nose.

What can be seen on an x-ray?

The healthy nasal cavity in the image has a clear border and an average thickness of the walls of the nasal cavity. When X-raying the maxillary sinus with suspicion of the initial stage of sinusitis, radiologists note thickening of the affected contours. This condition is characterized by the appearance of inflammation of the mucous membrane.

The ethmoid labyrinth is also visible in the image, because in this structure the accumulation of secretions occurs first. If darkening is not visible, then it is important to carefully examine the structure of the ethmoid bone tissue.

Infiltration or pus often causes the so-called “milk in a glass” symptom. This name comes from the property of the discharge to always be located in a horizontal position, no matter what position the patient occupies. Darkening with this symptom is either unilateral or bilateral. If the disease is advanced, then the accumulation of pus becomes total. This condition is fraught with the spread of purulent masses into neighboring tissues and vessels. There is an increased risk of infiltrate penetrating into the brain, which causes meningitis. When pus enters the bloodstream, it causes sepsis and inflammation of internal organs.

Accumulation of exudate with subtotal and total darkening also develops with the appearance of dense neoplasms in the nasal cavity, for example, chondroma, osteoma or sarcoma. Such cells may have a dense outer shell, but inside they will have a liquid consistency.

Is it necessary to take an x-ray?

If you suspect the development of a pathological process in the sinus cavity, radiography is necessary. Advanced pathology can lead to serious complications.

It is especially important to take an x-ray if the patient complains of a constant bursting headache, prolonged nasal discharge and increased body temperature.

Carrying out an x-ray procedure

Most often, they willingly prescribe a free X-ray examination as part of compulsory health insurance, which cannot be said about expensive examinations, such as computed tomography and magnetic resonance imaging. This is an undeniable advantage of X-ray studies.

Indications for radiographs

X-rays of the sinuses in adults are performed in three cases:

• there is a suspicion of the development of the disease;
• the therapy is not effective;
• a complication develops.

The causes of ear congestion due to sinusitis are described in this material.

Preparation

No special preparation of the patient for x-ray of the nose is required. This moment greatly increases the likelihood of obtaining a reliable examination result .

Carrying out

The procedure is simple:

1. The patient sits or lies in front of the X-ray machine, removing all metal jewelry and removable dentures.
2. A protective cape is put on the shoulders.
3. The X-ray specialist asks the patient not to move for several minutes and takes pictures.

To obtain complete information about all maxillary sinuses, filming is carried out in four projections. At this time, it is necessary to accurately follow the specialist’s commands, for example, touch the device with your chin or tilt your head: the quality of the results depends on this.

Peculiarities

In certain cases, an X-ray examination with contrast is performed. A special substance containing iodine is injected into the nasal sinuses, and this allows you to get a complete picture of acute or chronic sinusitis.

The X-ray technician should warn the patient that this substance may cause allergies . If this instruction is not followed, the patient, who is aware of his tendency to allergic reactions to iodine and its derivatives, must independently refuse to inject a contrast agent into the nasal sinuses.

What symptoms are expressed in exudative sinusitis are described here.

Contraindications

X-rays are prohibited in the presence of the following conditions:

• development of malignant tumors localized in the head area;
• any stage of pregnancy;
• lactation;
• younger children (up to seven years);
• allergic reactions to iodine (when performing radiography with contrast).

Preparing and performing radiography

Radiography of the paranasal sinuses does not require special preparation. This diagnostic procedure is carried out in two positions: lying or standing. During the procedure, the patient presses his chin close to the device, then, at the command of the radiologist, holds his breath for 30 seconds. The procedure itself takes no more than 1-2 minutes.

In children, this procedure is practically not used. X-rays are performed in children strictly for urgent reasons.

Interpretation of the radiograph

The presence of exudate in the nasal sinuses indicates the presence of an acute inflammatory process, and thickening of the walls of the nasal sinuses and narrowing of their lumen may indicate chronic inflammation.

Subtotal darkening of the maxillary sinuses

A horizontal fluid level may indicate inflammatory diseases of the maxillary sinuses (sinusitis).

Subtotal darkening with an upper horizontal level in the area of ​​the maxillary sinuses may indicate sinusitis.

If the darkening is localized in the frontal sinuses, then this indicates the development of frontal sinusitis.

To diagnose tumors, radiography with a contrast agent is performed. This helps to better see the location of the tumor and its size. When contrast is introduced, tumor formations “absorb” the pigment and become more visible.

Other diagnostic methods

If you suspect the presence of a pathological process in the paranasal sinuses, it is necessary to conduct a number of additional studies:

• Clinical blood test. It is carried out to assess the general condition of the body, and in the transcript of the analysis you can see whether there is an inflammatory process in the body.
• CT scan of the sinuses. It is carried out when the X-ray image is unclear, as well as when a malignant process is suspected.
• MRI. Helps evaluate not only the condition of bone structures, but also nerves, blood vessels and soft tissues.

Purpose of radiography of the maxillary sinuses

An X-ray of the nose is performed to determine the clinical picture of the disease after taking a blood test for sinusitis.

When assessing the results, the doctor answers the following questions:

• whether the patient has a disease;
• whether there are complications;
• does the treatment give results;
• assessment of the patient's condition after illness.

The treatment tactics depend on the answers received, so it is absolutely impossible to neglect diagnostic procedures for sinusitis.

Symptoms of sinusitis in adults without fever are described here.

Treatment for incomplete darkening of the maxillary sinuses

Treatment of inflammation of the sinuses is complex and includes symptomatic therapy, anti-inflammatory and antibacterial drugs.

For the treatment of children, antibacterial drugs are prescribed with caution. The most preferred antibiotics for treatment in childhood are penicillins and cephalosporins.

Vasoconstrictor drugs based on xylometazoline (Nazivin) are prescribed with caution in childhood . Such drugs should not be used in a child for longer than 5 days. You should also strictly adhere to the dosage.

Medicines

Surgery

Subtotal darkening of the maxillary sinuses in many cases responds quite effectively to conservative therapy, but if there is no effect, surgical intervention may be required.

For sinusitis, it may be necessary to “puncture” the maxillary sinus. This manipulation is necessary to remove accumulated pus from the sinus.

To do this, the otolaryngologist performs a puncture in the projection of the maxillary sinus with a special instrument. After which the purulent contents are drained. The doctor then rinses the sinuses with an antiseptic solution to prevent further inflammation.

The operation takes about 30 minutes. and does not require putting the patient under anesthesia. If cysts and neoplasms were identified during the examination of the sinuses, then in this case they are removed surgically under general anesthesia.

If a tumor is found, in addition to removing it, a biopsy is performed to find out the type of tumor. After receiving the results, the doctor chooses the further method of treatment.

Diagnostics

Only a doctor can prescribe competent treatment for parietal sinusitis. All methods and means of therapy are selected individually after diagnosis.

The first step is to collect an anamnesis with further rhinoscopy - the doctor examines the nasal passages using artificial lighting and special mirrors.

The outer part of the wings, nose and vestibule is first palpated. Rhinoscopy makes it possible to determine the condition and color of the mucous membrane, existing structural changes, and assess integrity. Parietal sinusitis is usually indicated by mild hyperemia and pallor of the epithelium, as well as too thin blood vessels and swelling. In addition to the above, the nature and amount of exudate is also assessed.

Folk remedies

Subtotal darkening of the maxillary sinuses can be treated using traditional methods. Medicines based on medicinal plants are also used in the treatment of inflammatory diseases of the upper respiratory tract. For this purpose, saline solutions, drops, and compresses are used.

The only contraindication is an allergic reaction to the components of the drug.

For young children under 1 year of age, traditional treatment methods should be used with caution so as not to provoke the development of an allergic reaction.

Mustard oil

Rhinitis and sinusitis can be treated with mustard oil. To do this, the oil must be slightly heated, but the temperature must be comfortable so that when the oil is instilled into the nose, the mucous membrane does not burn.

Place 3-4 drops of oil into each nasal passage 2 times a day. The oil has anti-inflammatory and antiviral effects, and also reduces swelling of the nasal mucosa.

Garlic

Garlic has antibacterial properties and can be used to make drops for the common cold. To do this, you need to take 2 cloves of garlic, pass through a press, place in gauze (folded in several layers) and squeeze out the resulting juice.

Then add 3-4 tbsp to the garlic juice. l. water or 2 tbsp. l. olive oil. This must be done so that garlic juice does not lead to a burn of the mucous membrane.

For the first use, 1 drop is instilled into each nasal passage. If no allergic reaction subsequently occurs, then you can instill 2-3 drops into each nasal passage for 7 days.

Such drops are prohibited for use by children. Since the mucous membrane in children has a more immature structure compared to adults. Instillation of such drops may cause burns.

In addition to drops, garlic can be used as an air disinfectant. To do this, the garlic is first peeled and cut into small pieces. Garlic is laid out on plates and placed at different ends of the room. Since garlic is a natural antiseptic, its action will deactivate viruses and bacteria that are released by a sick person.

Propolis solution

To treat sinusitis, use a propolis solution. To do this, take a 10% alcohol solution of propolis. Before use, dilute a small amount with water so as not to irritate the mucous membrane. You need to instill 1-2 drops into each nasal passage for 7 days.

Due to the alcohol content, this method of treatment is contraindicated for children.

Aloe juice

Aloe is used not only to treat inflammatory diseases, but also to prevent viral infections.

For this purpose, drops can be prepared from aloe juice. To do this, take aloe juice and mix it with water in a 3:1 ratio. If such drops are indicated for a small child, then the proportion is 5:1. You need to instill 2-3 drops into each nasal passage for 10 days.

Black radish

Any compresses are prohibited in the phase of acute inflammation, as well as at elevated body temperature. A black radish compress is effective in reducing swelling of the mucous membrane.

To prepare such a compress, you need to take one radish, peel it and grate it. Then you need to mix with vegetable oil and heat slightly. Apply the prepared pulp to the sinus area for 10 minutes. You can use thin cloth or gauze for this purpose. The course of treatment with this remedy is no more than 7 days.

Sea salt

A hypertonic sea salt solution can be purchased at a pharmacy, or you can prepare it yourself at home.

For this purpose, you need to take ½ teaspoon of sea salt and dissolve its contents in a glass of warm water. Then you need to draw the required amount of solution into a sterile syringe and rinse each nasal passage one by one. It is recommended to rinse your nose with saline solution up to 5 times a day.

Children need to rinse their nasal passages by instillation. Until the age of 3, the nasal passages should not be washed with sprays or a syringe. Since a strong stream of solution can promote the advancement of microorganisms to the auditory tube. Since the auditory tube in children is short, this can cause otitis media.

If a subtotal darkening is observed on the x-ray of the maxillary sinuses, this means that a pathological process has begun in them. In some cases, a number of additional diagnostic procedures may be required to clarify the diagnosis.