© Borgis - New Medicine 4/2011, s. 116-119
Małgorzata Dębska, *Magdalena Frąckiewicz, Mieczysław Chmielik
The orbital abscess in the data of Paediatric Otolaryngological Clinic of Warsaw Medical University in 2005-2011
Department of Pediatric Otolaryngology, Medical University of Warsaw, Poland
Head of Department: Prof. Mieczysław Chmielik, MD, PhD
Introduction. Complications can occur as a consequence of both acute and chronic sinusitis. Most frequently complications are caused by acute ethmoiditis or frontal sinusitis. The complications of paranasal sinusitis are divided into intraorbital, intracranial and osteomyelitis. The children with complications of paranasal sinusitis require hospitalization, treatment with combined intravenous antibioticotherapy and often surgical treatment.
Aim. The analysis of patients treated surgically for orbital complications of paranasal sinusitis.
Material and methods. The research included children that were operated for orbital complications of paranasal sinusitis in Paediatric Otolaryngological Clinic of Warsaw Medical University between January 2005 and February 2011. The data were collected retrospectively on basis of medical documentation.
Results. In the period 2005-02.2011 in Paediatric Otolaryngological Clinic of Warsaw Medical University 27 children were operated due to orbital complications of rhinosinusitis. The procedures that were performed most frequently were: ethmoidectomy with or without maxillary sinuses puncture and drainage of the abscess.
Discussion. In children complications of paranasal sinusitis occur more frequently than in adults. The localization of the inflammation within the eyeball (preseptal or retroseptal) plays an important role in deciding about the method of treatment. Surgical treatment should be carry out in following cases: subperiosteal abscess, orbital abscess or each case of deterioration of visual acuity or lack of improvement after exact preservative treatment.
The paranasal sinusitis can induce very serious complications. They can occur as a consequence of both acute and chronic sinusitis. Most frequently complications are caused by acute ethmoiditis or frontal sinusitis since topographical conditions are conductive to spreading the inflammation through veins, arteries, lymphatic vessels and also directly from dehiscences in bones (1-3). In children complications of paranasal sinusitis occur more frequently than in adults (4).
The complications of paranasal sinusitis are divided into intraorbital, intracranial and osteomyelitis. The intraorbital complications are divided (according to Chandlera) into (1, 3, 4):
– inflammatory oedema of the orbit,
– orbital cellulitis,
– orbital cellulitis with subperiosteal abscess,
– orbital abscess,
– cavernous sinus thrombophlebitis.
The symptoms of intraorbital complications of paranasal sinusitis include local symptoms, such as: eyesore, oedema and erythema of the orbit (fig. 1), blepharophimosis, restriction of eyeball movements, exophtalmus, deterioration of visual acuity and even blindness and general symptoms, such as: headache, fever, weakness, loss of appetite, apathy (1, 2, 5).
Fig. 1. Clinical representation of complication of acute paranasal sinusitis.
Each case of complications of paranasal sinusitis requires administration of immediate diagnostics, including paediatric, laryngological examination with evaluation of the orbit mobility and visual acuity, ophthalmological and neurological consultation. Immediate treatment is needed since the inflammation proceeds urgently and that can cause intracranial complications, sepsis or patient’s death. The computer tomography is a fundamental radiological examination in case of complications of paranasal sinusitis (1, 2, 6, 7) (fig. 2).
Fig. 2. Representation of complications of an acute paranasal sinusitis in CT.
The children with complications of paranasal sinusitis require hospitalization, treatment with combined intravenous antibioticotherapy and often surgical treatment. When deciding about the method of treatment, the location of inflammation is very important. The orbital septum is a membrane that originates from the orbital periosteum and inserts into the anterior surfaces of the tarsal plates of the eyelids, it separates the superficial eyelid from the deeper orbital structures. The preseptal cellulitis, the inflammation that is located anteriorly to the orbital septum, demands preservative treatment with topical nasal decongestants. Complications that are located posteriorly to the orbital septum demand combined treatment: preservative and most frequently surgical (1, 5, 6).
The particular analysis of patients treated surgically due to orbital complications of paranasal sinusitis.
MATERIAL AND METHODS
The research included 27 children that were operated due to orbital complications of paranasal sinusitis. The children were hospitalized in Paediatric Otolaryngological Clinic of Warsaw Medical University between January 2005 and February 2011. In the analyzed group there were 17 boys and 10 girls at the age from 2 months to 13 years and 7 months (mean age 6 years and 1 month). The data were collected retrospectively on the basis of medical documentation.
Since January 2005 and February 2011 in Paediatric Otolaryngological Clinic of Warsaw Medical University there were 124 children with acute rhinosinusitis hospitalized, 51 children were diagnosed with orbital complications and 27 were operated due to that reason.
The patients were estimated with regard for duration of symptoms before hospitalization, physical examination on admission, inflammatory parameters. In the majority of cases computed tomography of the sinuses with the assessment of the orbits was performed. At qualification to surgical treatment we took the results of physical examination, response for previous treatment and result of CT into consideration.
The average duration of symptoms before hospitalization was 4 days. All patients in physical examination presented a different degree of oedema and erythema of the eyelids. In 19 cases (70.4%) there were limitations of mobility of the orbit and exophtalmus stated. In other 8 cases the clinical condition was deteriorating in spite of the treatment and also the limitations of mobility of the orbit and exophtalmus occurred.
The majority of patients on admission presented increased inflammatory parameters, average results were as following: leukocytes – 15.4 x 103/uL (n: 4.5-13.0), OB – 70 mm/1 hour (n: 3-15), CRP – 6 mg/dL (n: 0-1).
In analyzed group of 27 patients, in 5 cases (18.5%) CT was not performed before the surgical procedures because the inflammatory lesions were spreading and also protrusion and mobility of the orbit were worsening. The results of CT, depending on described lesions were divided into 5 groups:
group I – haziness of the paranasal sinuses, without oedema of the soft tissues of the orbit, without signs of the abscess,
group II – infiltration, enhancement of the medial rectus muscle,
group III – oedema of the soft tissues of the orbit, with dislocation of the medial rectus muscle,
group IV – enhancement and dislocation of the medial rectus muscle, distraction of bones between the orbit and ethmoid sinus,
group V – bubble of the air inside the orbit (table 1).
Table 1. The distribution of the patients in each group.
|CT group||Amount of patients /%|
|group IV||2/7.5 %|
|group V||2/7.5 %|
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