EpistemisMaxillofacial fullness (sinus pressure)
Specialty: Otolaryngology.
Why it occurs
- Acute sinusitis of bacterial or viral origin with retention of purulent secretions
- Allergic fungal sinusitis with accumulation of thick eosinophilic mucin in the maxillary or frontal sinuses
- Sinus barotrauma due to blockage of the draining ostium during rapid changes in atmospheric pressure
- Atypical trigeminal neuralgia or tension headache that mimics the location of sinus pain
Initial workup
Nasal endoscopy with sampling from the middle meatus for culture if there is active suppuration, high-resolution CT of the paranasal sinuses without contrast to assess the occupation of the ethmoid cells, maxillary, frontal or sphenoid sinuses, and brain MRI if there is suspicion of an orbital or intracranial complication.
red flags
Erythema, edema or swelling of the periorbital region or cheek, alteration of external ocular motility (diplopia or limitation of movements), exophthalmos or proptosis of acute onset, severe decrease in visual acuity, intense holocranial headache associated with meningeal signs or refractory fever.
Standard management
- Amoxicillin-clavulanic acid — 875/125 mg every 8 hours orally for 10-14 days if acute bacterial origin is confirmed
- Nasal corticosteroids such as mometasone furoate — 2 sprays per nostril every 12 hours
- Analgesics/anti-inflammatories such as ibuprofen — 600 mg orally every 8 hours with food
- Nasal washes with hypertonic solutions of warm saline solution (to promote mechanical decongestion of the drainage ostium).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Otolaryngology
- Listed causes
- 4
- Treatment options
- 4