Intracranial and Orbital Complications of Sinusitis: A Review of Rhinologic and Multidisciplinary Management Principles.

Abstract

Objective: To provide an up-to-date review summarizing the pathophysiology and management of the most common orbital and intracranial complications of acute rhinosinusitis (ARS).

Methods: A narrative literature review was conducted using the following search criteria in the PubMed database: "sinusitis" AND "complications" AND ("orbital" OR "intracranial" OR "osseous" OR "Pott's puffy tumor"). Titles and abstracts were screened for relevance. Additional articles were found by hand-searching references. Articles were chosen for inclusion based upon relevance, quality, full-text availability, and date of publication. Common or interesting radiographic findings were highlighted as figures using patient imaging data based on senior author expert opinion.

Results: ARS is one of the most common diagnoses made in the United States. While the vast majority of these cases resolve with oral antibiotics and conservative medical management, rare instances of ARS may be complicated by the spread of infection into orbital, intracranial, and osseous spaces. This review seeks to guide physician management with evidence-based recommendations. The pathophysiology of complex sinusitis is explored and risk factors, evaluation, and up-to-date prevention and management recommendations are discussed. This review of the literature highlights that when orbital, intracranial, and osseus complications are suspected, a multidisciplinary team should be assembled to consider both medical and surgical management options. In this way, outcomes of these complex infections can be optimized.

Conclusions: ARS is common and self-resolving in most cases. However, clinicians should suspect orbital and intracranial complications in at-risk individuals with worsening symptoms that do not respond to standard therapies, and initiate early interventions as directed by multidisciplinary teams.