A case of orbital complications from sinusitis in a child

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We report an infantile case of orbital complications due to acute sinusitis. A 3-year-old previously healthy boy presented with fever, moist cough, purulent nasal discharge and periorbital swelling and proptosis on the right side. Computed tomography (CT) and magnetic resonance imaging (MRI) showed a medial subperiosteal orbital abscess and destruction of part of the medial wall of the orbital bone. The patient was treated with intravenous antibiotics (ceftriaxone) for two days, but the periorbital swelling and proptosis persisted. We performed endoscopic sinus surgery (ethmoidectomy and maxillectomy) and drained the subperiosteal abscess through bony dehiscence without removal of the entire lamina papyracea. Intraoperative cultures yielded no organisms. Swelling and proptosis were resolved, and the patient was discharged on postoperative day 6. Follow-up CT showed repair of the medial wall of the orbit and clear paranasal sinuses. In general, medical treatment for sinusitis with orbital complications is more effective for children than for adolescents. This case demonstrated that prompt surgical treatment is necessary for sinusitis with orbital complications when conservative therapy is not effective.
Japan Society for Pediatric Otorhinolaryngologyの論文