Bilateral Orbital Complications of Pediatric Rhinosinusitis

Abstract

Orbital complications of pediatric rhinosinusitis are usually unilateral at presentation. We describe 3 children with bilateral orbital cellulitis that occurred as a complication of rhinosinusitis. The children ranged in age from 11 to 14 years, had prolonged hospital stays that ranged from 10 to 19 days, and underwent multiple surgical procedures to drain subperiosteal and intraorbital abscesses. They appeared to have direct spread of disease from the ethmoid sinuses to both orbits, without intracranial spread of infection. Therefore, the presence of bilateral orbital complications of rhinosinusitis does not necessarily imply spread of disease to the cavernous sinus. Children who present with bilateral orbital complications of rhinosinusitis should be treated aggressively from the outset, since they suffer from a more widespread form of the disease.

Manifestations of Fungal Cellulitis of the Orbit in Children with Neutropenia and Fever

“…Complications of untreated or unrecognized orbital cellulitis include cosmetic deformities, visual loss, intracranial extension, and death. [1][2][3] Fungal orbital cellulitis is a devastating variant of orbital cellulitis, with mortality rates approaching 85%. 3,4 Fungal infections occur predominantly in the immunocompromised patient.…”

Periorbitale und orbitale bakterielle Entzündungen

“…In Übereinstimmung mit der aktuellen Literatur sehen wir aus eigener Erfahrung eine dringende Operationsindikation ab Stadium 3 nach Chandler, also eines Subperiostalabszesses [4,9,14,15,20,24,32,34,36]. Bei den selten auftretenden beidseitigen orbitalen Komplikationen ist ein frühzeitiges operatives Vorgehen angezeigt [19]. Die Orbitaphlegmone stellt mit ihren potenziellen Risiken eine absolute Operationsindikation dar.…”

Early cavernous sinus thrombosis following unilateral pansinusitis in a child

“…In spite of aggressive medical management, the incidence of permanent disability is high. Visual deficit occurs in one sixth of cases and half of them may have residual cranial nerve deficits 1. Valveless communications between facial and ophthalmic veins and the cavernous sinus help infections from the paranasal sinuses and orbit to spread to the cavernous sinus leading to the potential fatal cavernous sinus thrombosis (CST) 1.…”

“…Visual deficit occurs in one sixth of cases and half of them may have residual cranial nerve deficits 1. Valveless communications between facial and ophthalmic veins and the cavernous sinus help infections from the paranasal sinuses and orbit to spread to the cavernous sinus leading to the potential fatal cavernous sinus thrombosis (CST) 1. We report a rare case of CST following unilateral paranasal sinusitis in a child, managed successfully without any residual deficit.…”