Orbital Complications Secondary to Sinusitis in Children: The Endoscopic Approach

Orbital complications secondary to acute sinusitis are rare in children. They include preseptal cellulitis; an orbital subperiosteal abscess (OSA); an orbital abscess (OA), which may cause deterioration of visual acuity and restriction of globe motility; and finally, a life-threatening cavernous sinus thrombosis, meningitis, and/or a brain abscess. Orbital CT scan is the most accurate tool in the work-up of orbital complications.

The medical files and CT scans of 23 children were reviewed retrospectively. All were managed by IV antibiotics. Those who failed antibiotic treatment, or who developed limited motion of the orbit or reduced visual acuity, were operated on by endoscopic sinus surgery, except for one case.

Twelve children with an OSA were managed surgically. Three children who were diagnosed with an OSA were found to have an OA during the endonasal endoscopic surgery. Eleven children were cured without surgical intervention. Two of these suffered a subsequent recurrent OAS. No major complications occurred.

We emphasize the advantages of the endoscopic endonasal approach. We managed to successfully drain the OSA and the OA using this procedure, which also enabled us to overcome the disadvantages of the external approach, mainly postoperative facial scarring.