Orbital complications in pediatric acute sinusitis: eight-year experience

Authors

  • João Fonseca Neves Department of Otorhinolaryngology, Centro Hospitalar e Universitário de Coimbra
  • João Filipe Simões Faculdade de Medicina da Universidade de Coimbra
  • Sofia Paiva Department of Otorhinolaryngology, Centro Hospitalar e Universitário de Coimbra
  • Felisberto Maricato Department of Otorhinolaryngology, Centro Hospitalar e Universitário de Coimbra
  • Luís Filipe Silva Department of Otorhinolaryngology, Centro Hospitalar e Universitário de Coimbra

Keywords:

complications, orbital disease, sinusitis

Abstract

Objectives: Acute sinusitis accounts for up to 82% of orbital infection cases. Infection spreads very quickly, especially through the ethmoid sinus, and orbital complications may arise even under antibiotic therapy. The aim of this study was to describe an 8-year hospital experience with these children.

Methods: All cases of acute sinusitis with orbital complications admitted to the Department of Otorhinolaryngology of Centro Hospitalar e Universitário de Coimbra between 2010 and 2017 were retrospectively reviewed.

Results: Sixty-four patients met the inclusion criteria, with a mean age of 9 ± 4.7 years. Male:female ratio was 1.67:1. Most subjects were admitted in the winter period (57.8%), with 2.9 ± 2.5 days of clinical evolution. The mean Lund Mackay score was 10.6 ± 4.9, with maxillary and ethmoid being the most prevalent involved sinuses (96.4% and 94.6%, respectively), and was inversely correlated with age (p<0.05). Preseptal cellulitis was the most common complication (56.3%). Abscesses were identified in 18.7% of patients, but only four (6.25%) required surgery. Seven cases (10.9%) recurred shortly after hospital discharge and required prolonged antibiotic course. All patients recovered well, without further complications.

Conclusion: Results showed that orbital complications of sinusitis respond well to high doses of endovenous antibiotherapy and patients tend to recover without local comorbidities. Close monitoring of these patients during the first months after hospital discharge is crucial to prevent early relapse.

Downloads

Download data is not yet available.

References

Sciarretta V, Demattè M, Farneti P, Fornaciari M, Corsini I, Piccin O, et al. Management of orbital cellulitis and subperiosteal orbital abscess in pediatric patients: A ten-year review. Int J Pediatr Otorhinolaryngol. 2017;96:72-76.

https://doi:10.1016/j.ijporl.2017.02.031.

Bedwell JR, Choi SS. Medical versus surgical management of pediatric orbital subperiosteal abscesses. Laryngoscope. 2013;123(10):2337-2338. https://doi:10.1002/lary.24014.

Eviatar E, Sandbank J, Kleid S, Gavriel H. The role of osteitis of the lamina papyracea in the formation of subperiosteal orbital abscess in young children. Int J Pediatr Otorhinolaryngol. 2014;78(12):2267-2270. https://doi:10.1016/j.ijporl.2014.10.031.

Rubin F, Pierrot S, Lebreton M, Contencin P, Couloigner V. Drainage of subperiosteal orbital abscesses complicating pediatric ethmoiditis: comparison between external and transnasal approaches. Int J Pediatr Otorhinolaryngol. 2013;77(5):796-802. https://doi:10.1016/j.ijporl.2013.02.014

Chandler JR, Langenbrunner DJ, Stevens ER, The pathogenesis of orbital complications in acute sinusitis. Laryngoscope. 1970;80:1414-1428. https://doi.org/10.1288/00005537-197009000-00007.

Tanna N, Preciado DA, Clary MS, Choi SS. Surgical treatment of subperiosteal orbital abscess. Arch Otolaryngol Head Neck Surg. 2008;134(7):764-767. https://doi:10.1001/archotol.134.7.764.

Gonçalves R, Menezes C, Machado R, Ribeiro I, Lemos JA. Periorbital cellulitis in children: Analysis of outcome of intravenous antibiotic therapy. Orbit. 2016;35(4):175-180. https://doi:10.1080/01676830.2016.1176205.

Soon VT. Pediatric subperiosteal orbital abscess secondary to acute sinusitis: a 5-year review. Am J Otolaryngol. 2011;32(1):62-68. https://doi:10.1016/j.amjoto.2009.10.002.

Emmett Hurley P, Harris GJ. Subperiosteal abscess of the orbit: duration of intravenous antibiotic therapy in nonsurgical cases. Ophthalmic Plast Reconstr Surg. 2012;28(1):22-26. https://doi:10.1097/IOP.0b013e31822ddddc.

Stokken J, Gupta A, Krakovitz P, Anne S. Rhinosinusitis in children: a comparison of patients requiring surgery for acute complications versus chronic disease. Am J Otolaryngol. 2014;35(5):641-646. https://doi:10.1016/j.amjoto.2014.05.008.

Todman MS, Enzer YR. Medical management versus surgical intervention of pediatric orbital cellulitis: the importance of subperiosteal abscess volume as a new criterion. Ophthalmic Plast Reconstr Surg. 2011;27(4):255-259.

https://doi:10.1097/IOP.0b013e3182082b17.

Gavriel H, Yeheskeli E, Aviram E, Yehoshua L, Eviatar E. Dimension of subperiosteal orbital abscess as an indication for surgical management in children. Otolaryngol Head Neck Surg. 2011 Nov;145(5):823-7. https://doi:10.1177/0194599811416559. Epub 2011 Jul 21. PMID: 21778515.

Nation J, Lopez A, Grover N, Carvalho D, Vinocur D, Jiang W. Management of Large-Volume Subperiosteal Abscesses of the Orbit: Medical vs Surgical Outcomes. Otolaryngol Head Neck Surg. 2017;157(5):891-897.

https://doi:10.1177/0194599817728490.

Ryan JT, Preciado DA, Bauman N, Pena M, Bose S, Zalzal GH, et al. Management of pediatric orbital cellulitis in patients with radiographic findings of subperiosteal abscess. Otolaryngol Head Neck Surg. 2009;140(6):907-911. https://doi:10.1016/j.otohns.2009.02.014.

Tabarino F, Elmaleh-Bergès M, Quesnel S, Lorrot M, Van Den Abbeele T, Teissier N. Subperiosteal orbital abscess: volumetric criteria for surgical drainage. Int J Pediatr Otorhinolaryngol. 2015;79(2):131-135. https://doi:10.1016/j.ijporl.2014.11.021.

Taubenslag KJ, Chelnis JG, Mawn LA. Management of frontal sinusitis-associated subperiosteal abscess in children less than 9 years of age. J AAPOS. 2016;20(6):527-531.e1. https://doi:10.1016/j.jaapos.2016.08.007.

Quintanilla-Dieck L, Chinnadurai S, Goudy SL, Virgin FW. Characteristics of superior orbital subperiosteal abscesses in children. Laryngoscope. 2017;127(3):735-740. https://doi:10.1002/lary.26082.

Ketenci I, Unlü Y, Vural A, Doğan H, Sahin MI, Tuncer E. Approaches to subperiosteal orbital abscesses. Eur Arch Otorhinolaryngol. 2013;270(4):1317-1327. https://doi:10.1007/s00405-012-2198-x.

Brook I. Microbiology and choice of antimicrobial therapy for acute sinusitis complicated by subperiosteal abscess in children. Int J Pediatr Otorhinolaryngol. 2016;84:21-26. https://doi:10.1016/j.ijporl.2016.02.022.

Downloads

Published

2021-12-27

How to Cite

1.
Neves JF, Simões JF, Paiva S, Maricato F, Silva LF. Orbital complications in pediatric acute sinusitis: eight-year experience. REVNEC [Internet]. 2021Dec.27 [cited 2022Aug.15];30(4):207-12. Available from: https://revistas.rcaap.pt/nascercrescer/article/view/18998

Issue

Section

Original Articles

Most read articles by the same author(s)