摘要
現今因抗生素普遍使用的時代下，鼻及鼻竇炎所產生之併發症是很罕見的。但因鼻竇位置鄰近眼睛與腦部等重要器官，一旦發生併發症可能造成嚴重的後遺症。因此，具備處理鼻及鼻竇炎併發症的能力，是吾等耳鼻喉科醫師責無旁貸的使命。鼻及鼻竇炎的眼部併發症依據1970年Chandler氏分類，包括隔膜前蜂窩性組織炎、眼窩蜂窩性組織炎、骨膜下膿瘍、眼窩膿瘍及海綿竇血栓（但2020年EPOS指引將海綿竇血栓歸類於顱內併發症）。診斷端賴臨床表徵與及影像檢查，需積極地以抗生素治療，若24到48小時內病況沒進步，或出現視力衰退、大體積的膿瘍、全身的系統性症狀等情形，則須考慮手術介入。顱內併發症包括硬腦膜外膿瘍、硬腦膜下膿瘍、腦膿瘍、腦膜炎、上矢狀竇及海綿竇血栓等，常合併有中樞神經症狀，電腦斷層與磁振造影等影像檢查是診斷的黃金標準。治療上以廣效及可通過血腦障壁之抗生素為主，並以內視鏡手術做鼻竇引流，同時取得檢體做微生物培養。若有顱內膿瘍形成，則考慮合併膿瘍引流。其他較少見為骨性併發症，任何部位的鼻竇炎皆可能造成骨髓炎甚至形成骨膜下膿瘍，而以額竇炎所導致的Pott氏膨脹瘤（Pott's puffy tumor）最為人所知，治療上也需長期廣效性抗生素配合手術治療。即使這些併發症已經很少見了，但臨床上仍要提高警覺，早期發現、及時介入處理才可避免永久的後遺症或死亡產生。
並列摘要
Complications from rhinosinusitis are rare in the era of antibiotics. Because the paranasal sinuses are close to important organs such as the eyes and brain, complications may result in serious consequences. Therefore, dealing with these complications is critical. Ophthalmologic complications include preseptal cellulitis, orbital cellulitis, subperiosteal abscess and orbital abscess, which can be diagnosed based on clinical manifestations and image studies. Antibiotic treatment should be initiated promptly and properly. Surgical intervention can be considered if there is no clinical improvement in 24 to 48 hours or there is progressive visual loss, a large abscess or systemic involvement. Intracranial complications include epidural empyema, subdural empyema, brain abscess, meningitis, and superior sagittal and cavernous sinus thrombosis. The clinical manifestations usually involve the central nervous system. Computed tomography and magnetic resonance imaging are standard diagnostic tools. The mainstays of treatment are broad-spectrum antibiotics that can pass through the blood-brain barrier, and endoscopic surgery to drain the infected sinuses as well as to acquire specimens for culture. Transcranial abscess drainage should be reserved for those with abscess formation. Osseous complications occur less frequently. Osteomyelitis and even subperiosteal abscess can develop in any subsite of the paranasal sinuses. Pott's puffy tumor, caused by frontal sinusitis, is the most well known in this category, and usually requires long-term broad-spectrum antibiotics combined with surgical intervention. Although these complications are rare, clinicians need be alert to any signs of them. Early diagnosis and timely intervention can prevent permanent morbidity and mortality.
延伸閱讀
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