An orbital fistula complicating anaerobic frontal sinusitis and osteomyelitis

Abstract

Abstract. A patient is described with an orbital fistula complicating frontal sinusitis and osteomyelitis of the frontal bone. The fistula was excised, but a fortnight later an acute exacerbation occurred. From the discharging pus a Staphylococcus aureus was cultured and from mucosa obtained during surgery a microaerophilic Streptococcus. These findings led to the diagnosis: synergistic bacterial inflammation of the frontal sinus, with osteomyelitis and orbital cellulitis. Case reportA 20-year-old soldier visited the Outpatient Department of the Wilhelmina Gasthuis in September 1980. He presented a fistula above the right eyelid existing for five months, which opened periodically discharging pus and blood. He had suffered a fractured nose 18 months previously, with subsequent complaints of maxillary sinusitis. A few months later the right upper eyelid became swollen and a few months after that the swelling perforated and pus and blood were discharged. The patient was treated in another hospital for the maxillary sinusitis by a Caldwell-Luc operation. Antibiotics were administered for the fistula.On admission to our hospital a month after the first examination the patient presented a fistula opening above the right eyelid and below the right ear a solid lymph node of 2 cm diameter was palpated. A culture taken from the opening of the fistula yielded a beta-haemolytic and a green colouring Streptococcus. X-rays of the skull and orbit showed areas of decreased density in the frontal bone on both sides with a very vague superior margin on the right, indicating a destructive bone lesion. The fistula was excised and was found to originate in the frontal sinus, from which a biopsy was taken. Pathological examination showed a chronic, aspecific, inflammatory process; bacterial culture was negative. Blood examination showed raised IgA and a low number of T-cells.A fortnight later the patient was again admitted with an intensely swollen right upper eyelid and eyebrow. He was unable to open his eye and there was continuous discharge of pus and blood from the operation wound. Patient had tachycardia, no fever and a second degree, apical, systolic murmur. The 409 Documenta Ophthalmologiea 52, 409-414 (1982)

The rare presentation of a frontal mucocele complicated by a Pott’s puffy tumor and an epidural-cutaneous fistula: illustrative case

“…2 In 2008, Wu et al 3 reported 13 cases from the English literature published since 1950 with SCF as a complication of frontal sinusitis, 4 of which also had associated PPT (Table 1). [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] Simonin et al's 4 literature review after 2008 described 5 more cases of SCF and PPT as complications of chronic sinusitis and 1 case with post-traumatic right frontal craniotomy and cranial osteoplastic reconstructive surgery. There were only 3 reported cases of ECF associated with PPT as a complication of frontal sinusitis.…”

Pott’s Puffy Tumour: A Clinical Variant

“…The range of potential pathogens is remarkably wide, 17 –21 and commonly identified bacteria include aerobic and anaerobic streptococci, staphylococci and bacteroides species 2 , 5 . The low incidence of haemophilus, particularly in adults, 5 may reflect widespread use of the H. influenzae type B vaccination.…”

Clinical and Pathological Observation and Treatment of Chronic Orbital Osteomyelitis

“…Chronic orbital osteomyelitis is rare, with only scattered case reports available [3,4,5,6,7,8,9,10]. These reported that chronic orbital osteomyelitis was almost secondary to sinusitis or trauma accompanying retained foreign bodies.…”