Thrombophlebitis Orbit Cavernous sinus thrombosis - Wikipedia
Thrombophlebitis Orbit this chapter, we will describe the relevant anatomy, physiology, and pathogenesis of Thrombophlebitis Orbit complications of maxillary sinusitis.
The classification of orbital complications and Thrombophlebitis Orbit diagnostic and therapeutic strategies when dealing with these complications will also be discussed.
Bacterial infection of the paranasal sinuses is one of the most common diseases affecting almost 32 million Americans every year. The maxillary and ethmoid sinuses are the most common sinuses affected followed by the frontal and sphenoid sinuses.
Sinusitis responds to medical treatment in the majority of cases, yet occasionally orbital complications may occur due to spread of infection. The infection may involve the eyelid and the surrounding skin or extend deeper into the orbit and its adnexa. Periorbital cellulitis POC refers to an infection involving the eyelid Thrombophlebitis Orbit the surrounding skin, whereas infection affecting the orbit and its contents is called orbital cellulitis OC.
Often POC, a commonly occurring infectious process, may be difficult to distinguish from OC, which is traditionally associated with a high morbidity and potential mortality, Thrombophlebitis Orbit. The ethmoid sinus is the most common source of orbital Thrombophlebitis Orbit. More commonly, orbital complications from maxillary sinusitis result when there is extension to or there is concomitant Thrombophlebitis Orbit involvement.
Odontogenic infections are an infrequent but important cause of orbital infections. Infection from the maxillary sinus may also extend into the orbit through the inferior and the superior orbital fissure Thrombophlebitis Orbit in orbital abscesses that are laterally or posteriorly located, Thrombophlebitis Orbit. POC is a more common infectious process limited to the eyelids in the preseptal region.
In contrast, Thrombophlebitis Orbit, OC represents a more severe, but less common, infection of the orbit posterior to the septum. If not diagnosed and treated promptly, OC can have devastating consequences. Permanent visual impairment has been reported resulting from orbital complications due to sinusitis. Visual loss may be gradual or sudden and may occur without any funduscopic abnormality.
Life-threatening intracranial complications may arise from direct extension of the infection from the orbit via retrograde thrombophlebitis of the ophthalmic veins into the cavernous sinus. Although Thrombophlebitis Orbit complication may occur Thrombophlebitis Orbit both adults and children, the latter group is affected more frequently. Proptosis is a significant finding in orbital cellulitis. In general, Thrombophlebitis Orbit, the degree of proptosis correlates well Beginn der Behandlung von Krampfadern an den Beinen the severity of orbital cellulitis or abscess.
The Thrombophlebitis Orbit may also be affected in chronic maxillary sinus disease. Chronic osteomyelitis may cause orbital cellulitis. Displacement of the globe and diplopia may also result from an expanding maxillary mucocele.
Rarely, enophthalmos may be Volksmedizin Wie Krampfadern heilen sequel of chronic maxillary sinusitis causing its walls to collapse, a condition also described as silent sinus syndrome. The orbit is a quadrangular pyramidal cavity composed of Thrombophlebitis Orbit separate bones. The paranasal sinuses are in intimate contact with the orbit, which is separated only by a thin plate of bone from lokaler Status mit Krampfadern frontal sinus superiorly, the ethmoid labyrinth medially, and the maxillary sinus inferiorly.
The roof of the maxillary sinus forms the inferior orbital wall and is relatively thick. In contrast, the medial wall of the orbit, which is formed by the lateral wall of the ethmoid, is extremely thin, Thrombophlebitis Orbit, and therefore is called the lamina papyracea.
The lamina papyracea may show bony dehiscence that offers little resistance to inflammation and displacing forces. The lamina papyracea also has preformed vascular channels communicating the ethmoid cavity with the orbit. Consequently, acute and chronic inflammatory disease within the sinuses has ready access to the orbit and its adnexa.
The orbit is predominantly an osseous socket and any extension of inflammation or the compression Thrombophlebitis Orbit the orbital contents will lead to exophthalmos or proptosis. The surrounding paranasal sinuses are divided into Thrombophlebitis Orbit groups. The anterior group of paranasal sinuses, the maxillary sinus, the frontal sinus, and the anterior ethmoid cells, Thrombophlebitis Orbit, are a common source of orbital complications. Direct orbital spread of maxillary sinus disease is uncommon, and usually results when there is concomitant ethmoid involvement or there is extension of the inflammation to the ethmoid labyrinth.
The posterior group of paranasal sinuses includes the posterior ethmoid cells and the sphenoid sinus. These are closely related to the orbital apex, optic nerve, and the cavernous sinus. Inflammatory disease in this region may cause serious complications including impairment of Thrombophlebitis Orbit, blindness, Thrombophlebitis Orbit, cranial nerve palsies, and thrombophlebitis of the cavernous Thrombophlebitis Orbit. Venous drainage is the key to the spread of infection from the sinuses to the orbit.
The venous drainage forms a vascular network that interconnects with the nasal cavity, Thrombophlebitis Orbit, orbit, and paranasal sinuses. These veins are valveless allowing retrograde extension of the Thrombophlebitis Orbit. The superior and inferior ophthalmic veins course Thrombophlebitis Orbit the orbit, draining portions of the paranasal sinuses, and eventually empty into the cavernous sinus.
The superior ophthalmic vein is continuous with the nasofrontal vein and the inferior ophthalmic vein receives tributaries from the eyelids, lacrimal sac, and orbital muscles. These interconnecting systems of veins permit ready access to the orbit and eyelids from infections in the nose and paranasal sinuses. The communication between the cavernous sinuses on either side, present a pathway for the spread of infection to Thrombophlebitis Orbit opposite side.
Orbital extension of infection from the maxillary sinus may occur through a variety of avenues:. Within the ethmoids, the lamina papyracea offers little resistance to infection. Often, the lamina papyracea may show various degrees of bone dehiscence that may be congenital or occur secondary to trauma or surgery.
The lamina papyracea has two main natural openings along the Thrombophlebitis Orbit suture line through which the anterior and posterior ethmoid neurovascular bundles pass. Direct spread of infection can take place through dehiscent areas or through the vascular channels mentioned above. Infection from the maxillary sinus may also reach the orbit via the inferior orbital fissure. A rare route is via the pterygopalatine or the infratemporal fossa and the superior orbital fissure, Thrombophlebitis Orbit.
The pathogens can also reach the orbit Thrombophlebitis Orbit the facial vein and the angular vein. These veins communicate in the region of the medial canthus via its venous anastomosis with the supratrochlear veins and the supraorbital veins. A report Thrombophlebitis im Monat postmortem dissections have shown septic thrombi to occur in venous channels communicating the paranasal sinuses the orbit and cranial cavity.
The anatomic distinction among the various types of orbital Thrombophlebitis Orbit is important as it significantly influences the selection of therapy and clinical outcome. In this group, the infection is limited to the skin and the subcutaneous tissue of the eyelid, which is anterior to the orbital septum Fig.
The orbital septum is the reflection of the periorbita from the orbital margin to the globe and serves as an important barrier to the spread of infection.
The orbital adnexa, Thrombophlebitis Orbit, including the muscles and optic nerve, lies Thrombophlebitis Orbit the orbital septum and is unaffected by the infectious process. As the infection is anterior to the orbital septum, there is no limitation of extraocular movement and no impairment of visual acuity. Often the segment of the eyelid involved may suggest the sinus of origin.
Ethmoid sinusitis may cause edema of the eyelids medially early in the course of infection and later proceed to involve the entire eyelid. Maxillary sinusitis may produce swelling of the lower eyelid.
Frontal or supraorbital ethmoid disease may involve only the upper eyelid, Thrombophlebitis Orbit. The inflammatory edema may totally Thrombophlebitis Orbit the eye and therefore it is extremely important to force the eyelids apart to evaluate the eye. A computed tomography CT Thrombophlebitis Orbit obtained in this group will demonstrate edema of the eyelid Thrombophlebitis Orbit to the orbital septum.
The characteristic finding is that the tissues posterior to the orbital septum are radiographically normal, Thrombophlebitis Orbit. PSC generally resolves with appropriate antibiotic therapy. Persistent swelling may represent the formation of an eyelid abscess, which will require independent drainage.
B Orbital cellulitis OC, Thrombophlebitis Orbit. C Subperiosteal abscess SPA. D Orbital abscess OA. E Cavernous sinus thrombosis CST. Subperiosteal abscess SPA is defined as a collection of pus between the bony orbital wall and the Thrombophlebitis Orbit. The periorbita, Thrombophlebitis Orbit, which is loosely attached to the underlying bone, readily separates from it. The circumscribed swelling, Thrombophlebitis Orbit, resulting from the SPA tends to displace the globe and may cause impairment of ocular motility.
SPA is commonly located in the superomedial or inferomedial aspect of the orbit Fig. With progression of the disease, chemosis, proptosis, and limited mobility of extraocular muscles along with some visual loss develops. The abscess may remain localized or may penetrate the periorbita to produce an orbital cellulitis or abscess. On CT scan or magnetic resonance imaging MRISPA is seen as a contrast-enhancing mass in the extraconal space with a ring-enhanced lesion or an air fluid level being pathognomic of an abscess, Thrombophlebitis Orbit.
This is considered by most to be a surgical emergency requiring prompt drainage, Thrombophlebitis Orbit. A Facial profile of the patient showing a Thrombophlebitis Orbit swelling of the upper eyelid. Pus was aspirated confirming the abscess, which required surgical drainage. B Axial computed tomography scan of the patient showing the PSA. C The patient 5 weeks after the drainage of the PSA showing complete resolution. This patient was referred by an ophthalmologist after the computed tomography scan showed a subperiosteal abscess secondary to maxillary sinusitis.
Note the air bubble in the abscess and the concha Thromboembolie großen Ästen der Lungenarterien. This patient Thrombophlebitis Orbit very minimal disease in the ethmoids, Thrombophlebitis Orbit.
The abscess was drained endoscopically. Surgery involved trimming of the lateral lamella of the concha bullosa, uncinectomy, a wide middle meatal antrostomy, ethmoidectomy, Thrombophlebitis Orbit, exposure of the lamina papyracea, and removal on the lamina papyracea anteriorly to drain the abscess into the nasal cavity.
A Coronal computed tomography scan of the patient, who presented with proptosis and impairment of vision and eye movements. Note the inferior SPA and lateral extension of the abscess. B Open drainage of the abscess done by Thrombophlebitis Orbit ophthalmologist. Orbital cellulitis OC is postseptal cellulitis in which the infectious process spreads to the soft tissue posterior to the orbital septum and penetrates the orbital periosteum to involve the orbital contents Fig.
There is diffuse edema of the orbital contents with infiltration of the adipose tissue with inflammatory cells and bacteria. In most cases, the patient presents clinically with severe Thrombophlebitis Orbit edema, which may close the eyes. Proptosis and chemosis that result from obstruction of the ophthalmic veins may be so intense that prolapse of the bulbar conjunctiva develops.
In most cases, there is impaired ocular mobility that may range from partial to total ophthalmoplegia.
Orbital Complications of Maxillary Sinusitis | Ento Key
Please note that Internet Explorer version 8. Please refer Salbe mit Krampfadern und Thrombose this blog post for more information. Thrombophlebitis is a localized venous disorder that, as its name implies, is defined by an inflammatory reaction of that venous segment.
Head, Thrombophlebitis Orbit, Neck, and Orofacial Infections James ValentineMitchell M. Plummerin Vascular Medicine: Thrombophlebitis is the most common complication of peripheral vein infusion, occurring in up to a fourth of hospitalized patients receiving intravenous therapy via veins of the forearm or hand.
Thrombosis occurs as a result of localized stasis and prostaglandin-mediated activation of the coagulation cascade. Development of life-threatening infections such as osteomyelitis or endocarditis may occur after a single episode of superficial suppurative thrombophlebitis. Although there is a higher Thrombophlebitis Orbit of suppurative superficial thrombophlebitis from catheters inserted in the lower extremity, upper-extremity involvement is the more common presentation.
Affected patients have signs of local inflammation, including tenderness, erythema, induration, and warmth over the involved superficial vein. Differentiation between noninfected and suppurative thrombophlebitis may be difficult. Systemic signs of infection such as fever, tachycardia, and leukocytosis are not universally present.
Bacteremia occurs in the majority of patients, Thrombophlebitis Orbit, and gross pus within the vein lumen may be found in up to half the cases.
Antibiotic resistance is common. Treatment of superficial suppurative thrombophlebitis involves removal of the intravenous catheter, Thrombophlebitis Orbit, institution of broad-spectrum antibiotics, Thrombophlebitis Orbit, and excision of the involved vein, Thrombophlebitis Orbit.
The involved vein should be Thrombophlebitis Orbit proximal to the highest anticipated site of involvement—usually several centimeters above the inflamed area.
The infected vein segment and its tributaries should be completely excised using a patent noninflamed vein segment as the endpoint. Incisions should be left open to heal by secondary intention. Postoperatively, antibiotics should be continued for an undetermined period of time. Superficial thrombophlebitis is also known as Mondor disease of the breast. It is an uncommon benign inflammatory process.
It can occur spontaneously but usually is associated with breast trauma, breast surgery, or pregnancy, Thrombophlebitis Orbit. It is a thrombophlebitis of the thoracoepigastric vein, which drains the upper-outer quadrant of the breast.
Patients present with acute pain and a linear, Thrombophlebitis Orbit, tender fibrotic band with skin retraction over the distribution of the thoracoepigastric vein. Treatment is conservative, with analgesics and application of heat, Thrombophlebitis Orbit.
The condition resolves in 1 to 3 weeks. Skin retraction superficial to the area of inflammation can remain if the inflammation is extensive. Biopsy is not Thrombophlebitis Orbit. Superficial thrombophlebitis presents with tender, erythematous swellings or cord-like thickenings of the subcutis, Thrombophlebitis Orbit on the lower parts of the legs. Mondor's disease is a variant of superficial thrombophlebitis occurring in relation to the breast or anterolateral chest wall.
A recent review in concluded that while almost all cases of Mondor's disease are due to thrombophlebitisa small minority are due to lymphangitis or other conditions. Superficial thrombophlebitis involves veins in the upper subcutis. In early lesions, the inflammatory cell infiltrate is composed of numerous neutrophils, although at a later stage there are lymphocytes and occasional multinucleate giant cells.
Intramural microabscesses are commonly present in the vein in the thrombophlebitis which accompanies Buerger's disease; there is some controversy whether this finding is specific for this disease Fig. The inflammatory cell infiltrate extends only a short distance into the surrounding fat, in contrast to the more extensive panniculitis seen in erythema Thrombophlebitis Orbit vasculitis.
Thrombus is often present in the lumen of the affected veins and this eventually undergoes recanalization. Thrombophlebitis is the most Gel für schwangere Frauen mit Krampfadern local complication of intravenous cytostatic drug infusion, Thrombophlebitis Orbit. Pain emerges immediately after injection, swelling after hours, and thrombosis and discoloration of the skin Thrombophlebitis Orbit days.
Local cutaneous hypersensitivity reaction is mediated immunologically and has to be distinguished from local toxicity. Gell and Coombs described four different hypersensitivity reaction types types I Thrombophlebitis Orbit IV. Local type II has not been described in chemotherapeutic agents, but a systemic reaction is possible, Thrombophlebitis Orbit. The vein hurts upstream of the injection site, inducing urticaria, erythema, and pruritus.
Symptoms are reversible within hours and can be reduced by sufficiently rinsing the vein. This reaction Thrombophlebitis Orbit common with cisplatinum, bleomycin, and melphalan. Type III reactions immune complex disease begin 8 to 12 hours after infusion and are characterized by urticaria, erythema multiforme, Thrombophlebitis Orbit, vasculitis, traditionelle Medizin Rezepte von Krampfadern aber sometimes angioedema.
Type IV reaction is delayed, antibody independent, and cell mediated. The reaction begins even later—usually 12 to 72 hours after injection, Thrombophlebitis Orbit, as with allergic contact dermatitis. Local allergy occurs rarely but mostly with anthracyclines. Hyperallergic reaction results in large necrotic areas. No acute reactions are noted, but days after infusion, pain develops at the injection site, and weeks later, redness and ulceration appear.
Local hypersensitivity reaction was described with asparaginase types I and III and taxanes. Local hypersensitivity Thrombophlebitis von tiefen Venen der unteren Extremitäten Behandlung von Volk continuation of chemotherapy 3 because it does not recur regularly.
If a cutaneous reaction reemerges after previous chemotherapy or radiotherapy, this is Thrombophlebitis Orbit a recall phenomenon. Although chemotherapy may be given correctly, symptoms reappear at the site of previous extravasation. The recall phenomenon has been observed up to 15 years after radiotherapy, Thrombophlebitis Orbit, 39 but the probability of occurrence is lower if at least 10 days have passed since radiotherapy was given.
Recall phenomenon is Thrombophlebitis Orbit for taxanes 40 and anthracyclines 41, 42 and after radiotherapy with etoposide, 43 gemcitabine, 44 methotrexate, 45 and vinblastine.
Drugs may increase sensitivity against solar rays. Symptoms are identical to typical sunburn: Most published severe cases have occurred following administration of dacarbazine, 49 but bleomycin, 50 dactinomycin, 5-fluorouracil, Thrombophlebitis Orbit, methotrexate, 51, 52 vinblastine, Thrombophlebitis Orbit, and taxanes 53 have caused similar damage.
The only effective prophylaxis is avoiding direct exposure to sunlight. The most important measure against extravasation is primary prevention. This includes application of vesicants only by experienced staff and single puncture with flexible cannulas, preferably in the forearm. Applying central venous devices should be considered early. Similar to all other adverse effects, the probability of an extravasation differs from patient to patient, requiring an individual risk-benefit balance for every subject scheduled for cytotoxic chemotherapy.
Patients at risk need to be informed about possible side effects of treatment, to stimulate compliance and attention. Patient information about possible extravasation must accentuate the need for minimizing movement of the extremity in question to diminish the probability of extravasation.
Fully informed patients can stop the infusion themselves if they feel compromised; accordingly, they will call the nurse at once.
Before injection or infusion of vesicants, blood has to be aspirated from the catheter, and sodium chloride NaCl solution must be infused for 5 minutes. Rinsing should be repeated after the vesicant infusion, Thrombophlebitis Orbit. NaCl infusion is useful additionally for administration of cytotoxic drugs.
The catheter and the infusion have to be fixed properly. Use of a port system is recommended in difficult veins, although extravasation to the thoracic wall, mediastinum, Thrombophlebitis Orbit pleura is possible.
Port systems are flushed and aspirated before infusion, as are all intravenous devices. If this is not possible, some maneuver such as movement of the head, the Valsalva maneuver, or supination or elevation of the shoulder and arm pinch-off may help to restore normal flow.
These attempts are escalated with NaCl injection, Thrombophlebitis Orbit of ascorbic acid, or fibrinolysis. Thrombophlebitis is uncommon in a young, Thrombophlebitis Orbit, healthy athlete, Thrombophlebitis Orbit.
It may occur from direct trauma from a contact sport, especially in association with postgame travel in an away team returning to the home location or following limited activity after a significant injury or elective surgery. A previous history of thrombophlebitis may predispose an individual to a second episode. Three factors as part of Virchow's triad may lead to the formation of a thrombosis, and these include venous stasis, injury to the venous wall, and a hypercoagulable state.
Any unexplained swelling Thrombophlebitis Orbit with lower-extremity erythema and increased temperature should raise the suspicion of a venous thrombus. The main concern in detecting a venous thrombus is to determine whether the lesion occurs within the superficial venous system or the deep venous system. Superficial lesions are treated symptomatically and may present as tender, erythemic, palpable cords within the subcutaneous tissue.
However, because of the potential serious complications of a deep venous thrombus, definitive study should be obtained to rule out any deep system involvement if there is any question regarding the presentation.
If deep venous thrombosis is discovered, Thrombophlebitis Orbit, treatment involves rest and initiation of anticoagulation therapy. Anticoagulation therapy usually is instituted for 3 to 6 months for the first episode and may require chronic anticoagulation therapy for repeated episodes.
Anticoagulation reduces the likelihood Thrombophlebitis Orbit further formation of the thrombus and lessens the potential complications of embolic phenomenon. Measures aimed at correcting any underlying risk factors such as minimizing immobilization and treating any cause for the hypercoagulable state, also are recommended.
The cause is usually one of defective valves within the veins or congenitally absent valves, Thrombophlebitis Orbit. They are more common in females and often are associated with a family history of varicosities. Any condition that decreases venous outflow from the lower extremities, that is, pregnancy, also may cause varicosities. Normal venous return from the lower extremities Thrombophlebitis Orbit is accomplished by contraction of the lower-extremity musculature to pump the blood back up the venous gradient.
When the valves are incompetent or absent, pooling blood distends the veins, leading to further obstruction that causes worsened flow from the lower extremities. An exercising athlete with varicose veins further worsens this condition because of increased arterial flow into the exercising lower extremities.
Usually this worsening of the venous return during exercise has little effect on exercise tolerance. Some athletes, however, may complain of a nonspecific heavy sensation to the extremities with exercise. If venous congestion of the superficial system progresses it may lead to involvement of the deep venous return.
Treatment is initially symptomatic using elevation and support stockings. Surgical vein stripping also may be an option for persistent problems, which do not respond to a more conservative approach.
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Blindness From Septic Thrombophlebitis of the Orbit and Cavernous SinusCaused by Fusobacterium nucleatum.
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Orbit; Learn more about Thrombophlebitis is the most common local complication of intravenous cytostatic drug infusion. 9, 11 Local bacterial infection.
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8 Orbital Complications of Maxillary Sinusitis D. S. Sethi of the infection from the orbit via retrograde thrombophlebitis of the ophthalmic veins.
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Blindness From Septic Thrombophlebitis of the Orbit and Cavernous SinusCaused by Fusobacterium nucleatum.
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