P. 1
Orbital Complications of sinusitis

Orbital Complications of sinusitis

|Views: 347|Likes:
Published by Dr. Janarthanan V

More info:

Published by: Dr. Janarthanan V on Oct 21, 2010
Copyright:Attribution Non-commercial

Availability:

Read on Scribd mobile: iPhone, iPad and Android.
download as PPT, PDF, TXT or read online from Scribd
See more
See less

12/09/2013

pdf

text

original

ORBITAL COMPLICATIONS OF SINUSITIS

- N. ARAVINTHO

Epidemiology 80 ± 90% of cases. Peak incidence between 5 - 10 years 80% of patients <18 Y/O ( Younis et al 2002) Sinus infections are the most common cause of unilateral proptosis in children and the 3rd most common cause in adults following Graves¶ orbitopathy and pseudotumor Ethmoid sinusitis is most common cause , followed by Maxillary

Orbital Complications Of Sinusitis

Etiology
Direct extension of ethmoid sinusitis through thin lamina papyracea Retrograde bacterial phlebitis with intact lamina papyracea via: 1. The anterior & posterior ethmoidal neurovascular foramina 2. The ophthalmic venous system, the superior and inferior ophthalmic veins, are valveless, allowing for free-flowing communication of infection from the nose and ethmoid sinus to the orbit.(Chandler et al., 1970)

RELATION OF SINUSES TO ORBIT

Anatomy
Orbital septum is a thin fibrous tissue continuation of orbital rim periostium which extends to the tarsal plates Deep to posterior orbicularis fascia Anterior extent of orbit & Posterior extent of eyelid A Fascial barrier against the spread of periorbital infections into the orbit proper

GRADING OF ORBITAL CELLULITIS
G 1 : PRE SEPTAL CELLULITIS G 2: POST SEPTAL CELLULITIS G 3: SUBPERIOSTEAL ABSCESS G 4: ORBITAL ABSCESS G 5: CAVERNOUS SINUS THROMBOSIS SUPERIOR ORBITAL FISSURE SYNDROME ORBITAL APEX SYNDROME

Orbital Compartments  

Optic globe and septum divides the orbit into anterior and posterior compartments Localizing orbital disease to compartment helps generate a differential diagnosis.

PRE SEPTAL CELLULITIS
NO MARKED ERYTHEMA AND TENDERNESS OF THE LIDS ONLY OEDEMA OF THE LIDS OCCULAR MOVEMENTS AND VISION NOT AFFECTED UPPER LID INVOLVED IN FRONTAL , LOWER IN MAXILLARY AND BOTH IN ETHMOIDAL CELLULITIS

Orbital Cellulitis
Pre-septal cellulitis

9

Orbital Cellulitis
Post-septal (Orbital) Cellulitis

. Axial CE fat-suppressed T1-W MRI obtained in a 40fatT140Y/O man demonstrates right exophthalmos and heterogeneous enhancement of orbital (arrows) and Christina A. LeBedis, Osamu Sakai. RSNA, 2008 10 ‡ radiographics.rsnajnls.org periorbital (arrowhead) fat.

SUBPERIOSTEAL ABSCESS
ETHMOID SINUSES- UNDER PERIOSTEUM OF LAMINAPAPYRACEA PUSHES THE EYEBALL OUTWARD, LATERALLY, AND DOWNWARDS FRONTAL SINUSE- DOWNWARDS AND LATERALLY MAXILLARY SINUSES- UPWARD AND FORWARDS

Subperiosteal Abcess
Ä Ä Ä 

Ä Ä Ä

Subperiosteal abscess due to ethmoid sinusitis. Axial (a) and coronal (b) nonenhanced CT images obtained in a 24-year-old man depict a subperiosteal 24-yearabscess (arrow) along the medial wall of the right orbit,adjacent to the opacified ethmoid air cells, with resultant lateral displacement of the medial rectus muscle.. muscle..

Christina A. LeBedis, Osamu Sakai. RSNA, 2008 ‡ radiographics.rsnajnls.org

ORBITAL ABSCESS
SUBPERIOSTEAL ABSCESS BURSTS INTO ORBIT CAUSING ORBITAL ABSCESS HIGH FEVER OEDEMA OF THE LIDS PROPTOSIS CHEMOSIS OF CONJUNTIVA EYEBALL MOVEMENTS RESTRICTED VISION AFFECTED

Orbital Abscess

Child with an intraorbital abscess 2ry to ethmoid sinusitis

Post-Septal Orbital Abscess

SUPERIOR ORBITAL FISSURE SYNDROME
INFECTION OF SPHENOID SINUSES DEEP ORBITAL PAIN, FRONTAL HEADACHE PROGRESSIVE PARALYSIS OF CRANIAL N 4, 3 AND 6 IN THAT ORDER

ORBITAL APEX SYNDROME
SUP ORBITAL FISSURE SYNDROME + INVOLEMENT OF OPTIC NERVE AND MAXILLARY DIVISION OF TRIGEMINAL NERVE

Orbital Complications Of Sinusitis
Classification
1. 2. 3. 4. 5.

Periorbital (Pre-Septal) cellulitis (PreOrbital (Post-Septal) cellulitis (PostSubperiosteal Abscess Orbital abscess Cavernous Sinus Thrombophlebitis

Pre-Septal
More common Anterior to the septum Erythema/Edema eyelids No proptosis No Pain Normal vision No restriction of ocular movements/Painless No aff. Pupillary defect No abscess ±Fever

Post-Septal
‡ Less frequent <5y Posterior to the septum Massive eyelid swelling Proptosis Severe Pain Diminution of vision Restriction of ocular movements/Painful Afferent pupillary defect An abscess may form Fever

CLINICAL PRESENTATION
CHILDREN AND YOUNG ADULT COMONLY INVOLVED ORBITAL COMPLICATION MOSTLY ARISE AS COMPLICATION OF ACUTE ETHMOIDAL SINUSITIS OR RARELY ACUTE EXACERBATION OF CHRONIC SINUSITIS SWELLING AROUND EYE WITH H\O UPP. RESPIRATORY INFECTION

EYEBALL MOVEMENTS AND VISION DEPENDS ON THE GRADING (G 3 ONWARDS) VISUAL ACUITY AND COLOUR VISION MEASURE OF OPTIC NERVE

EXAMINATION
DIAGNOSTIC NASAL ENDOSCOPY FULL RANGE OF EYE MOVEMENTS DEGREE OF PROPTOSIS LIGHT REFLEX VISUAL ACUITY COLOUR VISION FUNDUS EXAMINATION

INVESTIGATION
TO DEFINE THE EXTENT AND SITE OF THE DISEASE CT SCAN OF ORBIT, PNS AXIAL AND CORONAL VIEW HEMATOLOGY : TC , DC , RBC COUNT , Hb URINE ANALYSIS : DIABETES MELLITUS

TREATMENT
MEDICAL MANAGEMENT FIRST LINE OF TREATMENT IV ANTIBIOTICS- BROAD SPECTRUM Like 3rd GENERATION CEPHALOSPORIN, CEFOTAXIME CEFTRIAXONE

SURGICAL MANAGEMENT
AIM IS TO TREAT COMPLICATION AND SINUSITIS SURGERY FOR ALL CASES WITH PROPTOSIS IRRELAVENT OF EYEBALL MOVEMENTS AND VISUAL ACUITY ENDOSCOPIC APPROCH: EXTERNAL APPROCH: LYNCH HOWARTH SURGERY

LYNCH HOWARTH SURGERY

DRAINAGE OF ABSCESS DRAINAGE TUBE EITHER INTO NASAL CAVITY OR DRAINED EXTERNALLY

ADMIT ALL EXCEPT PRESEPTAL INFLAMATION

ADMIT ALL EXCEPT PRESEPTAL INFLAMATION

IV ANTIBIOTICS , DECONGESTANT DROPS , ANALGESICS

BILATERAL VISUAL & NEUROLOGICAL SIGNS, CAVERNOUS SINUS THROMBOSIS

POOR VISUAL ACUITY / FIXED GLOBE

VISUAL ACUITY & COLOUR VISION NORAMAL BUT SIGNIFICANT PROPTOSIS

NO VISUAL LOSS , NO SIGNIFICANT PROPTOSIS

NO VISUAL LOSS NO SIGNIFICANT PROPTOSIS

CT WITHIN 24HRS

IMPROVEMENT

NO IMPROVEMENT

ORAL ANTIBIOTICS

SURGICAL DRAINAGE

VISUAL ACUITY, COLOUR VISION NORMAL BUT SIGNIFICANT PROPTOSIS

CT WITHIN 1-2 HOURS

DOESNOT IMPROVE

SURGICAL DRAINAGE

POOR VISUAL ACUITY / FIXED GLOBE

EMERGENCY 100 MINS TO SAVE EYE

SURGICAL DRAINAGE

BILATATERAL VISUAL AND NEUROLOGICAL SIGNS /SYMPTOMS OF CAVERNOUS SINUS THROMBOSIS

EMERGENCY CT

IV ANTIBIOTICS AND SURGICAL DRAINAGE

THANK YOU

You're Reading a Free Preview

Download
scribd
/*********** DO NOT ALTER ANYTHING BELOW THIS LINE ! ************/ var s_code=s.t();if(s_code)document.write(s_code)//-->