ppt blok 23
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![Page 1: ppt blok 23](https://reader033.fdocuments.net/reader033/viewer/2022061612/5695d3b41a28ab9b029edd32/html5/thumbnails/1.jpg)
Rhinosinusitis Maksilaris
Akut
![Page 2: ppt blok 23](https://reader033.fdocuments.net/reader033/viewer/2022061612/5695d3b41a28ab9b029edd32/html5/thumbnails/2.jpg)
RUMUSAN MASALAH • Seorang perempuan usia 28 tahun
datang ke poliklinik THT dengan keluhan pilek tidak sembuh-sembuh sejak 2 minggu yang lalu. Pasien juga mengeluh sering sakit kepala. Terdapat nyeri disekitar pipi bila ditekan
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ANALISIS MASALAH
RM
Anamnesis
PF & PP
WD & DD
Patofisiologi
Epidemiologi
Etiologi
Gejala klinik
Faktor resiko
Komplikasi
Penatalaksanaan
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Hipotesis• Pasien menderita rhinosinusitis
maksilaris akut
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Rhinosinusitis maksillaris akut
• Infeksi pada sinus tersering • Etiologi : virus, bakteri (strep.pneumonia,
H.influenzae), rhinitis alergika, rhinitis hormonal, hipertrofi adenoid (pd anak2),
• Kebanyakan pilek/flu hanya berlangsung 7 hari, jika > 7 hari pikirkan kemungkinan sinusitis
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Patofisiologi • Organ2 pembentuk KOM (sinus frontal,
maxila, ethmoid ante) letaknya berdekatan bila edema, mukosa akan saling berdempet shga silia tdk bergerak ostium tersumbat transudasi di rongga sinus
• Mula2 transudasi bersifat serous (rhinosinusitis non-bakterial) kondisi menetap bakteri tumbuh (rhinosinusitis akut bakterial)
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Klasifikasi sinusitis menurut waktu a
• Akut : sampai 4 minggu• Subakut : 4 minggu-3 bln• Kronik : > 3bln
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Gejala klinis • Rhinorhea (bersifat purulent)• Kongesti hidung• Sakit kepala• Demam, lemas• Nyeri tekan pd pipi/bawah kelopak mata• Post-nasal drip• Riwayat infeksi gigi• Reffered pain ke telinga dan dahi
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Anamnesis• Identitas : Wanita 28 thn • KU : pilek tdk sembuh2 sejak 2 mgg yll• RPS : sering sakit kepala, pipi sakit bila
ditekan• RPD : penyakit gigi? Hidung? Alergi?• RPK• RS : sering korek2 hidung? Korek telinga?
Merokok?
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Pemeriksaan Fisik• TTV• Keadaan Umum• Kesadaran• Rhinoskopi anterior : sekret kental di
meatus medius• Rhinoskopi posterior (post nasal drip)• Palapsi dan Perkusi regio maksila
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Pemeriksaan penunjang
• Foto sinus paranasal (PA, Lateral, Waters) : perselubungan sinus, air-fluid level
• CT-scan sinus paranasal : gold standar, tp tidak rutin utk sinusitisa akut. Indikasi : sinusitis kronik dan pre-operasi
• Pemeriksaan mikrobiologik dan tes resistensi
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komplikasi• Sinusitis kronis• Kelainan orbita : edema palpebra,
selulitis orbita, abses subperiosteal, abses orbita
• Kelainan intrakranial : meningitis, abses extradural/subdural, abses otak
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Tatalaksana • Antibiotik : harus diberikan 10-14 hari.
Penisilin, resisten : amok-clav, sefalosporin gen 2
• Decongestan : membuka KOM yg tertutup akibat edema mukosa sinus
• Simptomatik : analgetik, mukolitik, steroid oral/topikal, cuci rongga hidung (dgn NaCl/diaterimi), alargi berat (AH gen 2)
• Sinusitis kronis : operasi FESS
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Penatalaksanaan• Pembedahan
- Bedah Sinus Endoskopi Fungsional (BSEF)
- Irigasi sinus
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Prognosis• Dubia ad Bonam
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Diagnosis Banding
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Gejala Klinis• Gejala sistemik demam, lesu, sakit
kepala• Gejala lokal ingus kental, tersumbat,
menganggu penciuman• Gejala obyektif pembengkakan di
pipi dan kelopak mata bawah, mukosa konka hiperemis dan edema
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Diagnosis banding Rhinosinusitis edmoidalis akut Rhinosinusitis frontalis akut
Nyeri terutama di antara/belakang 2 bola mata
Nyeri terutama di dahi/seluruh kepala
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Kesimpulan• Hipotesis diterima