Orbital complications of acute rhinosinusitis in paeds: 10 years of our experience - An opportunity for a new therapeutic protocol
DOI:
https://doi.org/10.34631/sporl.740Keywords:
orbital complications, Chandler, acute rhinosinusitisAbstract
Objectives: Acute rhinosinusitisis a very common diagnosis in the paediatric population. Despite its usual favourable course, it can sometimes complicate, namely to the orbital compartment, which represents a threat to vision, even with appropriate and aggressive treatment. Our primary goal was to analyse the reality of a portuguese hospital during the past 10 years, discussing there sults and comparing them with the literature. We also propose a therapeutic protocol in cases of paediatric rhinogenic orbital complications.
Material and Methods: We conducted a retrospective descriptive study of all the cases of paediatric rhinogenic orbital complication cases treated at our tertiary care hospital between January 2007 and September 2017. We analysed the demographic data, symptoms at presentation, imaging findings, antibiotic choice, need for surgery and the length of hospital stay. We elaborated a therapeutic protocol for cases of orbital complications secondary to acute paediatric rhinosinusitis.
Results: 73% of the 137 children admitted for orbital complications secondary to acute rhinosinusitis did not present any relevant prior history. The mean age at presentation was 7 years old, being peri-orbital oedema and orbital pain the two most frequent symptoms at presentation. The majority of the children was classified as Chandler I (36%) followed by Chandler III (31%). The most frequently prescribed antibiotic regimen was the association of amoxicillin with clavulanic acid. The majority of cases resolved without the need for surgical intervention (84%).
Conclusions: The complications of acute rhinosinusitis are challenging due to the potential morbidity they can inflict. Timely diagnosis and aggressive medical treatment, combined in some selected cases with surgical treatment, achieve good outcomes. The existence of therapeutic protocols helps decision process, supporting the choices of the medical team.
References
Bibliografia:
Cheng J. et al, Adverse Events in Endoscopic Sinus Surgery for Infectious Orbital Complications of Sinusitis: 30-Day NSQIP Pediatric Outcomes. Otolaryngol Head Neck Surg. 2017 Oct;157(4):716-721.
Sultesz M. Acute bacterial rhinosinusitis and its complications in our pediatric otolaryngological department between 1997 and 2006. Int J Pediatr Otorhinolaryngol. 2009 Nov;73(11):1507-12.
Lance E. et al, Complications of Acute Sinusitis in Children, Otolaryngol Head Neck Surg. 2005 Jul;133(1):32-7.
Atfeh MS, Khalil HS. Orbital infections: five-year case series, literature review and guideline development. J Laryngol Otol. 2015 Jul;129(7):670-6.
Yen, Michael T., Johnson, Thomas E. (Eds.) Orbital Cellulitis and periorbital infections. Berlin: Springer; 2018. XV, 222 p.
Georgalas
Chandler JR, Langenbrunner DJ, Stevens ER. The pathogenesis of orbital complications in acute sinusitis. Laryngoscope. 1970 Sep;80(9):1414-28.
Domingues et al, Celulite Orbitária Pré e Pós-Septal em Idade Pediátrica: 17 Anos de Experiência, Acta Pediatr Port 2017;48:37-45.
Marchiano E. et al, Characteristics of Patients Treated for Orbital Cellulitis: An Analysis of Inpatient Data. Laryngoscope. 2016 Mar;126(3):554-9.
Harris GJ. Subperiosteal abscess of the orbit: older children and adults require aggressive treatment. Ophthalmic Plast Reconstr Surg. 2001 Nov;17(6):395-7.
Garcia GH, Harris GJ. Criteria for nonsurgical management of subperiosteal abscess of the orbit: analysis of outcomes 1988-1998. Ophthalmology. 2000 Aug;107(8):1454-6; discussion 1457-8.
Smith JM, Bratton EM, DeWitt P, Davies BW, Hink EM, Durairaj VD. Predicting the need for surgical intervention in pediatric orbital cellulitis. Am J Ophthalmol. 2014;158(2):387-394.
Bong AM, McIntosh D, Mahadevan M. Paediatric pre- and post-septal peri-orbital infections are different diseases. A retrospective review of 262 cases. Int J Pediatr Otorhinolaryngol. 2008 Mar;72(3):377-83.
Mathew AV, Craig E, Al-Mahmoud R, Bay R, Raghavan A, Mordekar SR, et al. Paediatric post-septal and pre-septal cellulitis: 10 years’ experience at a tertiary-level children’s hospital. Br J Radiol. 2014 Jan;87(1033):20130503.
Le TD, Liu ES, Adatia FA, Buncic JR, Blaser S. The effect of adding orbital computed tomography findings to the Chandler criteria for classifying pediatric orbital cellulitis in predicting which patients will require surgical intervention. J AAPOS. 2014 Jun;18(3):271-7.
Mahalingam-Dhingra A, Lander L, Preciado DA, Taylormoore J, Shah RK. Orbital and periorbital infections: a national perspective. Arch Otolaryngol Head Neck Surg. 2011 Aug;137(8):769-73.
