An Approach to Orbital Complications in Rhinosinusitis

Abstract

Objective: Whilst orbital complications arising from acute rhinosinusitis are infrequent in contemporary practice, the spread of infection orbitally or intracranially can result in severe complications and a high mortality. This study aims to review cases of orbital complications arising from rhinosinusitis in the light of the published literature on the topic.

Methods: Eight cases of individuals presenting to a particular clinic with the development of orbital complications following sinusitis within the previous four years were included in the study. The characteristic features of these cases in terms of diagnosis, treatment and follow-up were investigated.

Results: The mean age of all cases was 29.5 years. In three cases, orbital abscess, and in five cases, preseptal cellulitis, were observed as complications. Both surgical and medical treatment was administered in three cases, while medical treatment alone was used for five cases.

Conclusion: The region where the complications of rhinosinusitis are most commonly observed is the orbit, due to its proximity to the paranasal sinuses, especially the ethmoid cells. Where limitation of eye movements, proptosis, and a decrease in vision exists alongside an orbital abscess which itself has developed as a complication of sinusitis, surgical treatment is the most important option to consider to prevent complications. 

Keywords

• Orbit,sinusitis,orbital cellulitis,abscess

References

1. 1. Pereira FJ, Cruz AAV, Anselmo-Lima WT, Junior JE. Computed tomographic patterns of orbital cellulitis due to sinusitis. Arq Bras Oftalmol. 2006;69:513-8.
2. 2. Szyfter W, Bartochowska A, Borucki L, Maciejewsk A, Kruk-Zagajewska A. Simultaneous treatment of intracranial complications of paranasal sinusitis. European Archives of Oto-Rhino-Laryngology 2018; 275:1165-1173.
3. 3. Watkins LM, Pasternack MS, Banks M, Kousoubris P, Rubin PA. Bilateral cavernous sinus thromboses and intraorbital abscesses secondary to Streptococcus milleri. Ophthalmology 2003; 110:569-574.
4. 4. Rosenfeld RM, Piccirillo JF, Chandrasekhar SS, Brook I et al. Clinical practice guideline (update): adult sinusitis. Otolaryngol Head Neck Surg. 2015 ;152:1-39.
5. 5. Chandler JR, Langenbrunner DJ, Stevens ER. The pathogenesis of orbital complications in acute sinusitis. The Laryngoscope 1970; 80:1414-1428.
6. 6. Patel NA, Garber D, Hu S, Kamat A. Systematic review and case report: Intracranial complications of pediatric sinusitis. Int J Pediatr Otorhinolaryngol. 2016 ; 86:200-12.
7. 7. Segal N, Nissani R, Kordeluk S et al. Orbital complications associated with paranasal sinus infections - A 10-year experience in Israel. Int J Pediatr Otorhinolaryngol. 2016; 86:60-2.
8. 8. Teinzer F, Stammberger H, Tomazic PV. Transnasal endoscopic treatment of orbital complications of acute sinusitis: the Graz concept. The Annals of otology, rhinology, and laryngology. 2015; 124:368-373.

9. 9. Atfeh MS, Singh K, Khalil HS. Orbital infections: a complete cycle 7-year audit and a management guideline. Eur Arch Otorhinolaryngol. 2018 ; 275:2079-2088.
10. 10. Garcia GH, Harris GJ. Criteria for nonsurgical management of subperiosteal abscess of the orbit: analysis of outcomes 1988-1998. Ophthalmology. 2000; 107:1454-6.
11. 11. Yang M, Quah BL, Seah LL, Looi A. Orbital cellulitis in children-medical treatment versus surgical management. Orbit. 2009;28:124-36.
12. 12. Siedek V, Kremer A, Betz CS, et al. Management of orbital complications due to rhinosinusitis. Eur Arch Otorhinolaryngol. 2010;267:1881-6.
13. 13. Gavriel H, Jabrin B, Eviatar E. Management of superior subperiosteal orbital abscess. European archives of oto-rhino-laryngology: official journal of the European Federation of Oto-Rhino-Laryngological Societies 2016; 273:145-150.
14. 14. Jabarin B, Eviatar E, Israel O, Marom T, Gavriel H. Indicators for imaging in periorbital cellulitis secondary to rhinosinusitis. Eur Arch Otorhinolaryngol. 2018 ; 275(4):943-948.
15. 15. Oxford LE, McClay J. Medical and surgical management of subperiosteal orbital abscess secondary to acute sinusitis in children. International journal of pediatric otorhinolaryngology 2006; 70:1853-1861.
16. 16. Bedwell JR, Choi SS. Medical versus surgical management of pediatric orbital subperiosteal abscesses. The Laryngoscope 2013; 123:2337-2338.
17. 17. Sciarretta V, Demattè M, Farneti P et al. Management of orbital cellulitis and subperiosteal orbital abscess in pediatric patients: A ten-year review. Int J Pediatr Otorhinolaryngol. 2017 ; 96:72-76.
18. 18. Ketenci I, Unlu Y, Vural A, Dogan H, Sahin MI, Tuncer E. Approaches to subperiosteal orbital abscesses. European archives of oto-rhinolaryngology: official journal of the European Federation of Oto-Rhino-Laryngological Societies 2013; 270:1317-1327.
19. 19. Erickson BP, Lee WW. Orbital Cellulitis and Subperiosteal Abscess: A 5-year Outcomes Analysis. Orbit 2015; 34:115-120.
20. 20. F. Tabarino, M. Elmaleh-Berg_es, S. Quesnel, M. Lorrot, T. Van Den Abbeele, N. Teissier, Subperiosteal orbital abscess: volumetric criteria for surgical drainage, Int. J. Pediatr. Otorhinolaryngol. 2015;79: 131-135.
21. 21.Kim JH, Kim SH, Song CI, Kang JW. Imageguided nasal endoscopic drainage of an orbital superior subperiosteal abscess. The British journal of oral & maxillofacial surgery 2016; 54:e26-28.
22. 22. Roithmann R, Uren B, Pater J, Wormald PJ. Endoscopic drainage of a superiorly based subperiosteal orbital abscess. The Laryngoscope 2008; 118:162-164.
23. 23. D.E. Tunkel, Drainage of subperiosteal orbital abscess in children, in: D. Kennedy (Ed.), Master Techniques in Otolaryngology Head and Neck Surgery: Rhinology, Trevose, vol. 33, Wolters Kluwer, 2015, p. 287-297.
24. 24.Gavriel H, Yeheskeli E, Aviram E, Yehoshua L, Eviatar E. Dimension of subperiosteal orbital abscess as an indication for surgical management in children. Otolaryngology-head and neck surgery. 2011; 145:823-827.