Caseous sinusitis

Introduction to cheese sinusitis Roninitis caseosa is a kind of cheese-like substance that accumulates in the nasal cavity or sinus, erodes tissue and bone in a long time, and can cause nasal deformity in severe cases. In the past, this disease was called nasal cholesteatoma, but it lacked histological basis. In recent years, most scholars believe that the disease is due to nasal or nasal chronic purulent inflammation, nasal obstruction, poor drainage of secretions, and then cheese-like necrosis and purulent secretions in the mucosa, eventually forming a cheese-like substance in the nasal cavity or sinus. To. basic knowledge The proportion of illness: 0.3% Susceptible people: no specific population Mode of infection: non-infectious Complications: jaw cysts submandibular space infection

The cause of cheese sinusitis

1. Special infection theory

In 1868, Duplay proposed the theory of rhinorrhea due to two cases of nasal erysipelas complicated with caseous rhinitis, but there was no similar report. In 1889, Cozzollion found a tuberculosis-like bacterium in the cheese substance, which is thought to be linked to tuberculosis. Of the 35 cases with complete domestic data, only 1 case was associated with tuberculosis, and other cases were normal in the lungs. Therefore, the doctrine is based on insufficient. Some scholars believe that caseous rhinitis is caused by the formation of syphilis, and 16 of the 35 cases in China have blood Kang Kang reaction, only 2 cases are strongly positive, 2 cases are weakly positive, and other cases are negative, and pathological examination There has also been no evidence of a change in syphilis.

2, nasobiliary tumor disease theory

In 1889, Tillaux et al. proposed this theory, suggesting that caseous rhinitis is similar to cholesteatoma in the ear, but in 1900 Kelson's examination of the nasal mucosa and secretions of caseous rhinitis confirmed that the majority of patients with nasal mucosa remained columnar epithelium. Or breathe the epithelium. There were 23 cases of nasal mucosal pathology in China, most of which were inflammatory changes. Only 3 cases of nasal mucosa columnar epithelium showed squamous cell or squamous metaplasia. Therefore, the establishment of this doctrine still requires further observation and research.

3. Foreign body theory

From 1919 to 1920, Hill found 10 cases of caseous rhinitis patients with different foreign bodies in the nasal cavity. Of the 35 cases in China, 4 cases found nasal foreign bodies (nasal stones, teeth), so it is believed that nasal foreign body obstruction may become the triggering factor of this disease.

4, nasal polyps degeneration and necrosis theory

Sheicher et al. found that necrotic necrotic tissue was found in nasal cheese or in a necrotic necrotic nasal polyp, and that degeneration and necrosis of nasal polyps could form a cheese-like substance. Polson recalled that none of the previous cases had nasal polyps. Of the 35 cases in China, 12 had polyps or necrotic polypoids in the nasal cavity. Therefore, the theory is worthy of discussion. Nasal polyps obstruction and degeneration and necrosis may play a role in the pathogenesis of this disease, but in patients with a history of nasal polyps in the clinic, there is no cheese rhinitis, so consider the disease in addition to obstruction factors. In addition, there must be other more important pathogenic mechanisms.

5, dental lesion theory

Some scholars believe that dental diseases often cause cheeseous maxillary sinusitis. 50% of the cases analyzed and analyzed by the former Soviet Union are caused by dental diseases. Therefore, this disease is thought to be related to tooth extraction, root canal and caries. In China, only 13 cases of caseous maxillary sinusitis or caseous rhinitis involving the maxillary sinus have a history of extraction. Clinically, odontogenic maxillary sinusitis is more common, and caseous rhinitis and sinusitis can be rare. The reports of former Soviet scholars are not consistent, and the reasons for this are still to be studied.

6, trauma factors

Some scholars have found that many cases of caseous rhinitis and sinusitis are caused by trauma, bullet wounds on the cheeks, nasal sinus surgery may cause epidermal fragments to fall into the sinus or damage to the nerve endings in the sinuses due to trauma, and nutritional disorders occur, leading to nasal cavity. The inner columnar epithelium is denatured and becomes a stratified squamous epithelial cell, which causes osteonecrosis of the sinus wall. None of the domestic cases were caused by trauma.

7, nasal purulent inflammation and obstruction theory

Most scholars accept this theory and believe that caseous rhinitis is due to mechanical obstruction in the nasal cavity. It can be foreign body, abnormal nasal structure (such as nasal septum deviation, turbinate hypertrophy, etc.) and new organisms, resulting in poor drainage and accumulation of secretions. Combined with chronic suppurative inflammation, the nasal mucosal necrosis and purulent secretions are concentrated, and the pus cells are fatty degenerated, eventually forming a solid soft cheese-like substance.

In fact, clinical patients with chronic rhinitis and sinusitis are accompanied by nasal deformities, and cheese sinusitis is rare. Therefore, it is believed that the pathogenesis of cheese sinusitis is based on nasal obstruction combined with suppuration, and certain biochemical changes must occur. The latter still needs further investigation.

Cheese sinusitis prevention

1. Insist on exercise:

Always insist on physical exercise, especially cold-resistant exercise. You should breathe fresh air outdoors to improve blood circulation in the nasal mucosa.

2, wash your nose:

We breathe every day with our nose. Inhalation of a large amount of dust, viruses, sulfur dioxide and other exhaust gases and viruses in the air. As the first pass for the human body to deal with the air, the nose is constantly invaded by dirty air. Although the nasal mucosa has a filtering and cleaning effect, if the nose is washed frequently, the nasal cavity will function better.

Method: Use warm palm water or warm salt water. Inhale it by the nose, spit it out through the mouth or through the nose. Don't be afraid of trouble, more than a few times! It is best to wash your nose with cold water all year round, especially when washing your face in the morning, wash your nose with cold water several times to improve the blood circulation of the nasal mucosa and enhance the adaptability of the nose to weather changes. To prevent colds and other respiratory diseases.

3. Correct bad habits:

Digging your nose, pulling your nose, or cutting your nose is very bad for your small nose, because damage to the nose and nasal mucosa will not only cause nasal purulent infection. It can also cause diseases in the brain and ears.

4, health massage:

Proper health massage on the nose is very useful for enhancing the function of the nose. Such as point pressure Yingxiang and other acupuncture points, or use both hands to rub up and down the sides of the bridge of the nose dozens of times; or press the side of the nostrils to focus on the other side of the nose through ventilation, etc., is a good way to strengthen the nasal function.

5, how to do nose bleeding:

If you have a nose bleeding, do not lie down or look up, blood in the mouth must be spit out, do not swallow, so as not to stimulate the stomach, causing nausea and vomiting; at the same time immediately use the index finger and thumb to pinch from the depression on the outside of the nose Live on both sides of the nose, use the nose to compress the nasal septum easily bleeding area, usually 3 minutes to stop bleeding.

6, adjust the diet:

Eat less spicy and irritating foods. In the fall and early spring, you can eat more foods that have the effect of nourishing yin and moisturizing, keeping the stool smooth.

7, keep the nasal cavity moist:

In daily life, we must pay attention to ventilation and ventilation in the living room to reduce air pollution. If the climate is too rainy and too dry, take some appropriate measures, such as a little peppermint oil or sesame oil in the nasal cavity, or take some vitamins C, A, D, etc., to protect the nasal cavity.

Complications of cheese sinusitis Complications, jaw cyst, submandibular space infection

In most cases, cheese sinusitis occurs in the ipsilateral sinus. As the cheese sample accumulates, it can invade the mucosa and bone, causing bone absorption, destruction or dead bone formation. Face and jaw deformities often occur in the late stage.

Cases of cheese sinus symptoms Common symptoms Nasal congestion, runny nose and nasal secretions increase fatigue

The cheese sample is a semi-solid yellowish unstructured structure composed of amorphous debris such as pus cells, necrotic tissue, exfoliated epithelium, stearin, a small amount of cholesterol and calcium salt crystals; among them, fungi such as white streptomyces may be present. Microorganisms such as diphtheria, occasionally see foreign bodies, nose stones or dead bones. The pathological changes of the nasal mucosa vary depending on the severity of the disease. Inflammatory infiltration and hyperplasia occur in mild cases, mucosal degeneration, necrosis and granulation hyperplasia occur in severe cases, and bone destruction, external nasal deformation or fistula formation.

On one side, the disease is slow. The main symptoms are progressive nasal obstruction, purulent nasal discharge, a small amount of nosebleeds, decreased sense of smell and dizziness, headache, loss of appetite. If invading the sphenoid sinus, it can damage vision and cranial nerve palsy.

Examination of cheese sinusitis

Check the accumulation of cheese in the nasal cavity, perforation of the nasal septum, deformation of the external nose, displacement of the eyeball, visible anterior wall of the maxillary sinus or hard fistula. In the early X-ray film, the sinus was uniformly blurred, and in the advanced stage, sinus cavity enlargement and bone destruction were observed. Biopsy only shows chronic inflammation and must be differentiated from malignant tumors.

Quickly repair the high-efficiency biotin contained in the rhinitis combination, which is quickly absorbed by the human body and directly acts on the pharynx, nasal mucosa, sinus, phlegm and blood circulation, clearing away heat and detoxification, releasing pre-ex vivo voxels, stimulating the differentiation, proliferation and adjustment of plasma cells. The nasal secretion function repairs the damaged and atrophied pharyngeal mucosa, nasal mucosa and sinuses, restores its physiological functions, immune function, rebuilds the lymphatic tissue defense barrier and restores the nasal filtration and humidification function to achieve complete repair and improvement of the nasal mucosa The ultimate goal of secretion.

Diagnosis and differentiation of caseous sinusitis

Cheese sinusitis should be differentiated from fungal infections, malignant granulomas and nasal sinus malignancies, especially when the disease enters the late stage and is more likely to be confused with nasal sinus malignant tumors.

Qi Lijie et al reported in 1995 that 6 cases were diagnosed as maxillary sinus cancer and then confirmed by surgical exploration and pathological examination as caseous maxillary sinusitis. Therefore, bone destruction by CT scan cannot be simply diagnosed as maxillary sinus cancer, which should be from the maxillary sinus. Density, uniformity, CT value and characteristics of bone destruction were identified.

1, density: cheeseous maxillary sinusitis density is low, uniform, CT value 30 ~ 50Hu, and nasal sinus tumor density is high, uneven, CT value above 60Hu.

2, bone destruction: cheese rhinitis, sinusitis, no obvious soft tissue mass, often manifested as bone compression and thinning, sinus cavity is obviously enlarged, while nasal sinus tumor has obvious soft tissue mass, bone is osteolytic destruction, The bone destruction was irregular and interrupted, and the sinus cavity expansion was not obvious. Cai et al reported 143 cases of maxillary sinus cancer with 6 cases of caseous maxillary sinusitis, while only 17 cases of cheeseous maxillary sinusitis were treated at the same time, indicating that 1/3 of cases of caseous maxillary sinusitis may be associated with malignant tumors. Therefore, we should be vigilant and do a comprehensive examination, including pathological examination, comprehensive analysis to prevent misdiagnosis.

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