Orbital complications of rhinogenic etiology in children: some aspects

Abstract

Introduction. Rhinosinusogenic orbital complications (RSOC) rank first among all serious complications of inflammatory diseases of the paranasal sinuses and require timely diagnosis and an interdisciplinary approach in the administration of this category of patients.The aim of the study. was to study the features of the nature of the course, diagnosis and tactics of managing children with RSOC according to the children’s ENT department of the OKB No. 2, Tyumen.Materials and methods. A retrospective analysis of the medical records of children with RSOC was carried out. The leukocyte shift indices (LSI) were calculated. The microbiological landscape in purulent RSOC and the tactics of introducing patients with these complications were studied.Results and Discussion. Among the entire pathology of the paranasal sinuses, RSOS were observed in 12.9% of cases. In 53.6% of cases, RSOC occurred in boys. Reactive edema of the tissue of the eyelids and orbits was in 86.1% of cases, other forms were less common. Of the microflora, the leading positions were occupied by Staphylococcus spp. In 54.2 % of cases, only conservative therapy was used, in every third case − minimally invasive manipulations, in 11 % − surgery. In 84.6 % of cases, empiric therapy was started with protected aminopenicillins, 3rd generation cephalosporins (12.8 %). In the presence of a subperiosteal abscess or phlegmon of the orbit (23.1 %), a transfer was made to reserve preparations. LSI values greater than 3.58 were more typical for purulent-septic complications of the eyelids and orbit, which required early surgical intervention and prevention of intraorbital and intracranial complications.Conclusion Among RSOC in children, reactive edema of eyelids and eye sockets predominates. The microbial landscape in purulent orbital complications was characterized by pronounced polymorphism, which makes it difficult to choose empirical antibiotic therapy. Calculation of the LSI allows for early diagnosis and timely therapy with the choice of the optimal scope of medical intervention and an interdisciplinary approach, which reduces the risk of developing purulent-septic complications of the orbit and eyelids.