Acute sinusitis is often a mild self_limiting disease but it can easily spread to the orbit due to close anatomic relationship and venous drainage.The most common complication in acute sinusitis is orbital infection and occur more frequently in pediatric population and it is a therapeutic emergency. Orbital inflammation is classified by Chandlers classification into five stages as:1)periorbital cellulitis,2)orbital cellulitis,3)subperiosteal abscess,4)orbital abscess and 5)cavernous sinus thrombosis. Fever, headache and orbital or facial swelling are most common presenting symptoms.Computed Tomography is the basis for early recognition and evaluation and sufficient treatment.Broad spectrum antibiotics and emergency surgical drainage of the affected sinus and the orbital abscess form the mainstay of treatment.
Material and method:
We gathered the information of 24 patients(7-13 years old)with orbital complications due to acute sinusitis retrospectively from january 2007 to may 2011 in Shahid mostafa Khomeini hospital.
18 patients(%75)had periorbital cellulitis and lid edema, 5 patients(%20/83) had orbital cellulitis and 1 patient(%4/17) had subperiosteal abscess.The most common symptoms were;fever and nasal purulant discharge(%84) and facial and periorbital swelling(%79).Coronal paranasal sinus CT scan and ophthalmologic examination were done for all patients and all complications were due to ethmoid sinusitis.All patients were treated with broad spectrum antibiotics and decongestant except for one patient with subperiosteal abscess that needs surgery(endoscopic sinus surgery )and drianage of abscess.All patients responded well without any sequele.
Orbital complications due to acute sinusitis in pediatrics are emergent and immediate management has good prognosis.Therefor nany unusual symptom in acute sinusitis such as swelling, lid edema, pain and disturbed vision must bee attentioned.
Keywords:orbital complications ,acute sinisitis,endoscopic sinus surgery