Because of the close proximity of the paranasal sinuses to the brain and eyes, serious orbital and/or intracranial complications can result from acute bacterial sinusitis and progress rapidly.

Orbital complications, including periorbital cellulitis and orbital cellulitis are most often secondary to acute bacterial ethmoiditis. Infection can spread directly through the lamina papyracea, the thin bone that forms the lateral wall of the ethmoidal sinus. Periorbital cellulitis produces erythema and swelling of the tissues surrounding the globe, whereas orbital cellulitis involves the intraorbital structures and produces proptosis, chemosis, decreased visual acuity, double vision and impaired extraocular movements, and eye pain.

Evaluation should include CT scan of the orbits and sinuses with pediatric ophthalmology and pediatric otolaryngology consultations. Then we can move on to treatment. Treatment with intravenous antibiotics should be initiated. Orbital cellulitis may require surgical drainage of the ethmoidal sinuses

Treatment with broad-spectrum intravenous antibiotics (usually cefotaxime or ceftriaxone combined with vancomycin) should be initiated immediately, pending culture and susceptibility results. In 50% the abscess is a polymicrobial infection. Abscesses may require surgical drainage.

Intracranial complications can include epidural abscess, meningitis, cavernous sinus thrombosis, subdural empyema, and brain abscess . Children with altered mental status, nuchal rigidity, or signs of increased intracranial pressure (headache, vomiting) require immediate CT scan of the brain, orbits, and sinuses to evaluate for the presence of intracranial complications of acute bacterial sinusitis.

Treatment with broad-spectrum intravenous antibiotics (usually cefotaxime or ceftriaxone combined with vancomycin) should be initiated immediately, pending culture and susceptibility results. In 50% the abscess is a polymicrobial infection. Abscesses may require surgical drainage.

Other complications include osteomyelitis of the frontal bone (Pott puffy tumor), which is characterized by edema and swelling of the forehead, and mucoceles, which are chronic inflammatory lesions commonly located in the frontal sinuses that can expand, causing displacement of the eye with resultant diplopia. Surgical drainage is usually required.

Leave a Reply

Your email address will not be published. Required fields are marked *