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The management of sinogenic orbital complications

Published online by Cambridge University Press:  29 June 2007

Bharath Singh
Bharath Singh*
Affiliation:
Department of Otorhinolaryngology, Faculty of Medicine, University of Natal, Durban, South Africa.
*
Address for correspondence: Dr B. Singh, Department of Otorhinolaryngology, Faculty of Medicine, University of Natal, Congella 4013, South Africa.
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Abstract

The place of conservative treatment in sinogenic orbital complications has not been fully explained in the literature. The question that remains unresolved is – at which stage of the disease is surgery indicated?

A study was undertaken in 240 patients with sinogenic orbital complications, to determine this. The patients were divided into three groups according to the stage of the disease as determined clinically: Group 1 (52 patients) with early stage disease, as detected by cellulitis only; Group 2 (76 patients) with intermediate stage, as detected by periorbital cellulitis and proptosis, but with full range of eye movement and unaltered vision: Group 3 (122 patients) with late stage disease, as detected by periorbital cellulitis and gross proptosis. with limitation of eye movement and altered vision.

Group I and Group 2 patients were treated conservatively, with intravenous antibiotics and antral lavage. Group 3 patients were treated with intravenous antibiotics and surgery. External frontoethmoidectomy was performed in 31 (bilateral in two), ethmoidectomy in 91 (bilateral in five), sphenoidectomy in 15 and bilateral antral washout in all (122 patients). There was 100 per cent success with conservative treatment in Group 1 patients, whilst in Group 2 there was 98.6 per cent failure. The 75 patients in whom conservative treatment failed were successfully treated with surgery: frontoethmoidectomy was performed in 66 and ethmoidectomy in nine. In Group 3 patients, 100 per cent success was achieved with intravenous antibiotics and surgery.

Sinogenic orbital complications can be treated conservatively and surgically, depending on the stage of the disease on presentation. Conservative treatment is only suitable for early complications, i.e. patients with periorbital cellulitis only. For disease beyond this stage i.e. intermediate and late stage disease, surgery is the treatment of choice.

Keywords

Ethmoid sinusitiscomplicationsOrbital diseases
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 109 , Issue 4 , April 1995 , pp. 300 - 303
Copyright
Copyright © JLO (1984) Limited 1995

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References

Bilaniuk, L. T., Zimmerman, R. A. (1980) Computer-assisted tomography: sinus lesions with orbital involvement. Head and Neck Surgery 2: 293–301.Google Scholar
Chandler, J. R., Langenbrunner, D. J., Stevens, E. R. (1970) The pathogenesis of orbital complication in acute sinusitis. Larvngoscope 80: 1414–1428.Google Scholar
Gellady, A. M., Shulman, S. T., Ayoub, E. M. (1978) Periorbital and orbital cellulitis in children. Pediatrics 61: 272–277.Google Scholar
Goldberg, F., Berne, A. S., Oski, F. A. (1978) Differentiation of orbital cellulitis from preseptal cellulitis by computed tomography. Pedatrics 62: 1000–1005.Google Scholar
Goodwin, W. J., Weinshall, M., Chandler, J. R. (1982) The role of high resolution computerized tomography and standardized ultrasound in the evaluation of orbital cellultiis. Larynoscope 92: 728–731.Google Scholar
Guindi, G. M. (1983) Acute orbital cellulitis: a multidisciplinary emergency. British Journal of Oral Surgery 21: 201–207.Google Scholar
Haynes, R. E., Cramblett, H. G. (1967) Acute ethmoiditis: its relationship to orbital cellultis. American Journal of Diseases of Children 114: 261–267.Google Scholar
Healy, G. B., Strong, M. S. (1972) Acute periorbital swelling. Laryngoscope 82: 1491–1498.Google Scholar
Macy, J. I., Mandelbaum, S. H., Mickler, D. S. (1980) Ocular pathology for clinicians and orbital cellulitis. Ophthalmology (Rochester) 87: 1309–1313.Google Scholar
Mills, R. P. (1986) Orbital infection and sinusitis. Journal of the Royal Society of Medicine 79: 68–69.Google Scholar
Mills, R. P., Kartush, J. M. (1985) Orbital wall thickness and the spread of infection from the paranasal sinuses. Clinical Otolaryngology 10: 209–216.Google Scholar
Moloney, J. R., Badham, N. J., McRae, A. (1987) The acute orbit preseptal (periorbital) cellulitis. subperiosteal abscess and orbital cellulitis due to sinusitis. Journal of Laryngology and Otology 12 (Suppl.): 1–18.Google Scholar
Morgan, P. R., Morrison, W. V. (1980) Complications of frontal and ethmoid sinusitis. Laryngoscope 90: 661–666.Google Scholar
Robbins, K. T., Tarshis, L. M. (1981) Blindness: a complication of odontogenic sinusitis. Otolaryngology – Head and Neck Surgery 89: 938–940.Google Scholar
Schramm, V. L., Myers, E. N., Kennerdell, J. S. (1978) Orbital complications of acute sinusitis: evaluation, management and outcome. Otolaryngology 86: 221–230.Google Scholar
Schramm, V. L., Curtin, H. D., Kennerdell, J. S. (1982) Evaluation of orbital cellulitis and results of treatment. Laryngoscope 92: 732–738.Google Scholar
Smelt, A. T., Migdal, C. S. (1983) Acute binding sinusitis. British Medical Journal 287: 1051–1052.Google Scholar
Smith, A. T., Spencer, J. F (1948) Orbital complications resulting from lesions of sinuses. Annals of Otology, Rhinology and Laryngology 57: 5–27.Google Scholar
Wald, E. R., Pang, D., Milmoe, G. J., Schramm, V. L. (1981) Sinusitis and its complications in the pediatric patient. Pediatric Clinics of North America 28: 777–796.Google Scholar
Watters, E. C., Wallar, P. H., Hues, D. A., Michaels, R. H. (1976) Acute orbital cellulitis. Archives of Ophthalmology 94: 785–788.Google Scholar
Welsh, L. W., Welsh, J. J. (1974) Orbital complications of sinus disease. Laryngoscope 84: 848–856.Google Scholar
Williamson-Noble, F. A. (1954) Disease or orbit and its contents secondary to pathological conditions of the nose and paranasal sinuses. Annals of Royal College of Surgery (England) 15: 46–64.Google Scholar