Orbital complication of acute ethmoiditis: A Tunisian paediatric cross sectional study
Author links open overlay panelAsma BenMabroukaSelmenWannesadeMehdiHasnaouibdAminaWerdaniadNouha BenHamidabdSaidaJerbicdNabilDrissbdBahriMahjoubade
a
University Hospital Thar Sfar, Mahdia Pediatric Department, 5100 Mahdia, Tunisia
b
University Hospital Thar Sfar, ENT Department, 5100 Mahdia, Tunisia
c
University Hospital Thar Sfar, Radiology Department, 5100 Mahdia, Tunisia
d
Monastir University, Faculty of Medicine, 5019 Monastir, Tunisia
e
Applied Epidemiology in Maternal and Child Health (LR 12 SP 17), Tunisia
Received 5 October 2019, Available online 31 October 2019.
https://doi.org/10.1016/j.amjoto.2019.102320Get rights and content
Abstract
Objective
The anatomical and developmental particularities of sinus cavities in paediatric population lead acute ethmoiditis to be the earliest form of sinusitis in children. Orbital complications are frequent and could lead to visual and neurological impairment. This study investigated the clinical, biological and radiological features of orbital complications. We identified the predictive factors of severe ophthalmological lesions and/or associated cerebral complications of acute ethmoiditis.
Design and methods
This cross sectional study included all patients identified as having orbital extension of acute ethmoiditis in the database of a single academic paediatric care centre over a period of 14 years. All orbital and cerebral Scans of the included patients were reviewed and the cohort was classified using Chandler's classification as having less severe lesions (Chandler's 1 and 2) or more serious lesions (Chandler's 3, 4 and 5).
Results
In total, 16 patients (12 girls and 4 boys) were included among 39 consecutives cases of ethmoiditis recessed with a complication rate of 41%. Average consultation delay was 4.88 days. The mean age was 4.37 years. Fever was objectified in 13 cases (81%). Six patients (37.5%) had exophthalmos. Orbital extension spectrum was: stage I (n = 4, 25%), stage II (n = 4, 25%), stage III (n = 6, 37.5%), stage IV (n = 1, 6.5%), stage V (n = 1, 6.5%) and intra cranial extension was associated in two cases. Univariate analysis showed that fever, exophthalmos, ophthalmoplegia, positive CRP, age and white blood cells count were not associated with more severe lesions in the CT scan. Initially, all children received intravenous antibiotic treatment. Association of multiple antibiotics was prescribed in 75% of the cases. With 21.07 days ± 5.51 days as a total treatment duration. Only Four patients underwent surgical treatment.
Conclusion
Orbital complications of ethmoiditis are frequent. No clinical or biological criteria seem to predict the severity of orbital lesions. Both orbital and brain CT scan could help detect eventual complications on time to adapt antibiotic treatment and eventually bring forward surgical intervention.
Keywords
Ethmoid sinusitisOrbital cellulitisBrain abscessPaediatrics
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© 2019 Published by Elsevier Inc.
Author links open overlay panelAsma BenMabroukaSelmenWannesadeMehdiHasnaouibdAminaWerdaniadNouha BenHamidabdSaidaJerbicdNabilDrissbdBahriMahjoubade
a
University Hospital Thar Sfar, Mahdia Pediatric Department, 5100 Mahdia, Tunisia
b
University Hospital Thar Sfar, ENT Department, 5100 Mahdia, Tunisia
c
University Hospital Thar Sfar, Radiology Department, 5100 Mahdia, Tunisia
d
Monastir University, Faculty of Medicine, 5019 Monastir, Tunisia
e
Applied Epidemiology in Maternal and Child Health (LR 12 SP 17), Tunisia
Received 5 October 2019, Available online 31 October 2019.
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https://doi.org/10.1016/j.amjoto.2019.102320Get rights and content
Abstract
Objective
The anatomical and developmental particularities of sinus cavities in paediatric population lead acute ethmoiditis to be the earliest form of sinusitis in children. Orbital complications are frequent and could lead to visual and neurological impairment. This study investigated the clinical, biological and radiological features of orbital complications. We identified the predictive factors of severe ophthalmological lesions and/or associated cerebral complications of acute ethmoiditis.
Design and methods
This cross sectional study included all patients identified as having orbital extension of acute ethmoiditis in the database of a single academic paediatric care centre over a period of 14 years. All orbital and cerebral Scans of the included patients were reviewed and the cohort was classified using Chandler's classification as having less severe lesions (Chandler's 1 and 2) or more serious lesions (Chandler's 3, 4 and 5).
Results
In total, 16 patients (12 girls and 4 boys) were included among 39 consecutives cases of ethmoiditis recessed with a complication rate of 41%. Average consultation delay was 4.88 days. The mean age was 4.37 years. Fever was objectified in 13 cases (81%). Six patients (37.5%) had exophthalmos. Orbital extension spectrum was: stage I (n = 4, 25%), stage II (n = 4, 25%), stage III (n = 6, 37.5%), stage IV (n = 1, 6.5%), stage V (n = 1, 6.5%) and intra cranial extension was associated in two cases. Univariate analysis showed that fever, exophthalmos, ophthalmoplegia, positive CRP, age and white blood cells count were not associated with more severe lesions in the CT scan. Initially, all children received intravenous antibiotic treatment. Association of multiple antibiotics was prescribed in 75% of the cases. With 21.07 days ± 5.51 days as a total treatment duration. Only Four patients underwent surgical treatment.
Conclusion
Orbital complications of ethmoiditis are frequent. No clinical or biological criteria seem to predict the severity of orbital lesions. Both orbital and brain CT scan could help detect eventual complications on time to adapt antibiotic treatment and eventually bring forward surgical intervention.
Keywords
Ethmoid sinusitisOrbital cellulitisBrain abscessPaediatrics
View full text
© 2019 Published by Elsevier Inc.
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