Unilateral periorbital swelling in children: avoid delays in diagnosis

2021 ◽  
Vol 14 (2) ◽  
pp. e237487
Author(s):  
Saroj Gupta ◽  
Deepak Soni
Keyword(s):  
Orbital Cellulitis ◽  
Sinus Surgery ◽  
Delay In Diagnosis ◽  
Preseptal Cellulitis ◽  
Ocular Movements ◽  
Intracranial Complications ◽  
Life Threatening ◽  
The Right ◽  
Delays In Diagnosis ◽  
Periorbital Swelling

A 10-year-old child had painful periorbital swelling in the left eye. It was diagnosed as preseptal cellulitis and treated with oral antibiotics. Three days later, the ocular condition worsened so the child was referred for further management. On examination, the child had a temperature of 102 °F. Ocular examination revealed proptosis, restricted ocular movements and a relative afferent pupillary defect in the left eye. Ocular examination of the right eye was normal. There was a history of recurrent episodes of cold in the past. CT scan orbit and sinuses revealed signs of orbital cellulitis with sinusitis on the left side. The child was treated with parenteral antibiotics and endoscopic sinus surgery. A child presenting with unilateral periorbital swelling needs to be thoroughly evaluated. It is important to differentiate orbital cellulitis from preseptal cellulitis. Orbital cellulitis is an emergency and delay in diagnosis can lead to vision and life-threatening intracranial complications.

scholarly journals Concomitant orbital and intracranial abscess

2020 ◽  
pp. 189-194
Author(s):  
Andreea Nae ◽  
Stephen Farrell ◽  
Kieron Sweeney ◽  
Siobhan Hoare ◽  
Michael Colreavy
Keyword(s):  
Endoscopic Sinus Surgery ◽  
Pediatric Population ◽  
Sinus Surgery ◽  
Intracranial Abscess ◽  
Case Presentation ◽  
Intravenous Antibiotics ◽  
Intracranial Complications ◽  
Life Threatening ◽  
Team Setting ◽  
Periorbital Swelling

Background:  Intracranial and orbital abscesses in combination together are rare complications of sinusitis. They can be life-threatening and can result in multiple sequelae. Case presentation: A 9-year-old female presented with left periorbital swelling, gaze restriction and headache. Following scans, she underwent emergency endoscopic sinus surgery, evacuation of the intraorbital empyema and stereotactic mini-craniectomy with the evacuation of the extradural empyema as a joint case. The patient recovered well and was discharged to complete intravenous antibiotics for 6 weeks. Conclusion: In the pediatric population intracranial complications of acute sinusitis can have more devastating consequences. Therefore prompt recognition and management are essential within a multidisciplinary team setting. We also highlight the rarity of concomitant multi-site abscess formation and the need to be vigilant for same.

scholarly journals Orbital Emphysema after a Protracted Episode of Sneezing in a Patient with no History of Trauma or Sinus Surgery

2010 ◽  
Vol 89 (11) ◽  
pp. E12-E13 ◽  
Author(s):  
Qasim A. Khader ◽  
Khader J. Abdul-Baqi
Keyword(s):  
Signs And Symptoms ◽  
Sinus Surgery ◽  
Blowout Fracture ◽  
Orbital Emphysema ◽  
The Face ◽  
History Of ◽  
Limiting Condition ◽  
The Right ◽  
Systemic Antibiotics ◽  
Periorbital Swelling

Orbital emphysema is a benign self-limiting condition. It can occur directly (as a result of trauma to the face) or indirectly (secondary to a blowout fracture). We report a case of orbital emphysema in a 38-year-old man who presented with ecchymosis of the right eye, pressure within the right orbit, and periorbital swelling following a protracted episode of vigorous sneezing. The diagnosis was confirmed by computed tomography. Systemic antibiotics were given, and the patient was cautioned to avoid blowing his nose. His signs and symptoms resolved within 1 week.

Don't sue the surgeon: remineralisation of the skull base or a defect that never existed?

2011 ◽  
Vol 125 (12) ◽  
pp. 1294-1297
Author(s):  
C Hopkins ◽  
S Dhillon ◽  
G Rogers ◽  
D Roberts
Keyword(s):  
Computed Tomography ◽  
Skull Base ◽  
Endoscopic Sinus Surgery ◽  
Semicircular Canals ◽  
Time Frame ◽  
Sinus Surgery ◽  
Operative Exploration ◽  
Intracranial Complications ◽  
Operative Findings ◽  
The Right

AbstractIntroduction:Intracranial complications are recognised as rare, but serious, sequelae of endoscopic sinus surgery.Case report:A 56-year-old woman was referred after developing meningitis following elective functional endoscopic sinus surgery. Computed tomography demonstrated a significant defect of the skull base in the right posterior ethmoid, clearly visible on both coronal and sagittal sections. Operative exploration demonstrated the skull base to be intact in the posterior ethmoid area identified on the scan, and the overlying mucosa appeared undisturbed. Scans were reviewed in the light of operative findings; coronal and sagittal images were found to be reconstructions. Directly acquired coronal computed tomography, undertaken three weeks after surgery, demonstrated a complete bony plate in the right posterior ethmoid at the site previously identified as dehiscent.Discussion and conclusion:We speculate that the posterior ethmoid defect was actually an artefact of reconstruction. We cannot exclude the alternative possibility of remineralisation, but given the time frame this seems unlikely. This case highlights the need for caution when interpreting reconstructed images of the thin bony plates of the skull base and lamina papyracea, as regards both clinical significance and medicolegal reporting. While virtual defects have been reported in the superior semicircular canals as a result of reconstructed images, we believe this to be the first reported case demonstrating a similar problem in the anterior skull base.

scholarly journals Devastating sight- and life-threatening laser blepharoplasty complications

2020 ◽  
Vol 2 (2) ◽  
pp. 134-139
Author(s):  
Muhammad Nazrin bin Muhammad Nordin ◽  
Sujaya Singh ◽  
Azida Juana Bt Ab Kadir ◽  
Nor Fadhilah bt Mohamad ◽  
Lott Pooi Wah
Keyword(s):  
Cosmetic Surgery ◽  
Anterior Segment ◽  
Unusual Complication ◽  
Incision And Drainage ◽  
Delayed Treatment ◽  
Life Threatening ◽  
The Right ◽  
Air Pockets ◽  
Systemic Antibiotics ◽  
Periorbital Swelling

A 53-year-old woman was referred to our centre by a private aesthetic clinic. She presented with bilateral severe periorbital swelling and reduced visual acuity in her left eye for three days prior to presentation. She had undergone CO2 laser blepharoplasty one week prior to assessment. Ophthalmic examination revealed periorbital swelling in both eyes with pouring pus discharge from the lower lid as well as underlying erythematous and ulcerative skin. There was limitation of extraocular muscle movement and conjunctival chemosis. Right-eye vision was 6/9, left-eye vision was counting fingers secondary to anterior segment inflammation. No sign of optic nerve involvement was noted. Computed tomography findings showed rim-enhancing preseptal collections with air pockets bilaterally involving the lower eyelids and measuring 2.6 x 4.3 x 2.7 cm on the left and 2.3 x 4.2 x 2.8 cm on the right with an extension of the collection into the lateral extra-conal region. She was treated as bilateral orbital cellulitis secondary to postsurgical infection. The patient underwent incision and drainage and started with systemic antibiotics promptly. She showed significant improvement after treatment. This is an unusual complication from cosmetic surgery in which delayed treatment can lead to sight- and life-threatening complications.

scholarly journals Pediatric Preseptal and Orbital Cellulitis: Analysis of Clinical, Laboratory and Imaging Findings of 123 Cases.

2021 ◽  
Author(s):  
Lida Bülbül ◽  
Neslihan Ozkul Saglam ◽  
Gizem Kara Elitok ◽  
Zahide Mine Yazıcı ◽  
Nevin Hatipoglu ◽  
...  
Keyword(s):  
Clinical Laboratory ◽  
Orbital Cellulitis ◽  
Ocular Involvement ◽  
C Reactive Protein ◽  
Predisposing Factor ◽  
Preseptal Cellulitis ◽  
Orbital Involvement ◽  
Reactive Protein ◽  
Pediatric Age Group ◽  
The Right

Abstract Background: To compare the clinical and laboratory characteristics and imaging methods of patients diagnosed with preseptal cellulitis and orbital cellulitis in the pediatric age group. Methods: The study was designed retrospectively and the medical records of all patients who were hospitalized with the diagnosis of preseptal cellulitis and orbital cellulitis were reviewed. The findings of preseptal cellulitis and orbital cellulitis groups were compared. The risk factors for the development of orbital involvement were analyzed. Results: A total of 123 patients were included, 90.2% with preseptal cellulitis and 9.8% with cellulitis. The male gender ratio was 60.2% and the mean age was 72±43 months. While all patients had eyelid swelling and redness 20.3% had fever. Ocular involvement was 51.2% in the right eye and 4.9% in both eyes. The most common predisposing factor was rhinosinusitis (56.1%). Radiological imaging (Computed tomography/magnetic resonance imaging) was performed in 83.7% of the patients. Subperiostal abscess were detected in 7 cases (5.6%) which three of the cases were managed surgically and four were treated with medically. The levels of c-reactive protein were significantly higher in patients with orbital involvement (p:0.033) but there was no difference between the presence of fever, leukocyte and platelet values. Conclusions: Rhinosinusitis was the most common predisposing factor in the development of preseptal cellulitis and orbital cellulitis. Orbital involvement was present in 9.8% of the patients. It was determined that high c-reactive protein value could be used to predict orbital involvement. Keywords: Childhood, preseptal cellulit, rhinosinusit, orbital cellulit, subperiostal abscess.

scholarly journals Orbital cellulitis: early intervention saves vision

2019 ◽  
Vol 7 (1) ◽  
pp. 203
Author(s):  
N. Rajeshwari ◽  
A. Savitha
Keyword(s):  
Early Diagnosis ◽  
Soft Tissues ◽  
Orbital Cellulitis ◽  
Invasive Technique ◽  
Endoscopic Drainage ◽  
Predisposing Factor ◽  
Subperiosteal Abscess ◽  
Preseptal Cellulitis ◽  
Common Location ◽  
Life Threatening

Orbital cellulitis describes an infection involving the soft tissues posterior to the orbital septum including the fat and muscle within the bony orbit. This condition is associated with severe sight and life-threatening complications. Distinguishing it from preseptal cellulitis is difficult, but important. Acute sinusitis is the commonest predisposing factor. Clinical findings alone are not specific enough to distinguish between preseptal and post septal orbital cellulitis. Early diagnosis using CT orbit is important to rule out complications such as orbital cellulitis, subperiosteal abscess. The most common location of subperiosteal abscess is the medial wall of the orbit. Transnasal endoscopic drainage of the abscess is a functional and minimally invasive technique and is the treatment of choice at present. Early diagnosis and intervention are mandatory to prevent the visual loss and life-threatening complication.Here, the authors describe a 2 months old infant with orbital cellulitis and medial subperiosteal abscess and treated with transnasal endoscopic drainage of the subperiosteal abscess.

scholarly journals Pott’s Puffy Tumor - Overview of case series

2021 ◽  
Vol 3 (1) ◽  
pp. 10-17
Author(s):  
Luiz Severo Bem Junior ◽  
Márcia Noelle Cavalcante Medeiros ◽  
Luan de Sá Pinto Nóbrega Gadelha ◽  
Wagner José Raia Neri ◽  
Marie Anne Gomes Cavalcanti
Keyword(s):  
Case Series ◽  
Etiologic Agent ◽  
Sinus Surgery ◽  
External Drainage ◽  
Subperiosteal Abscess ◽  
Male Adolescents ◽  
Pott’S Puffy Tumor ◽  
Intracranial Complications ◽  
Life Threatening ◽  
Male Subjects

Pott’s puffy tumor (PPT) is rare and usually seen as a complication of frontal sinusitis that has been neglected or partially treated, resulting in subperiosteal abscess of the frontal bone with underlying osteomyelitis, which can lead to life-threatening intracranial complications, such as epidural/subdural empyema, cerebral abscess and meningitis. Given this, the purpose of the present study was to gather the most diverse cases reported together to highlight the main treatment methods. Methods: It is a narrative review, starting from the search in the database PubMed, Lilacs and Scielo from 2010 to 2020, which resulted in 34 scientific articles. The search focused on obtaining data on new approaches and treatments established for Pott’s puffy tumor. Results: 34 articles were included which described 58 patients with a swollen Pott tumor, occurring predominantly in male adolescents, with streptococci (26,1%) as the main etiologic agent. Approximately 84% of all patients were male subjects. The most prevalent intracranial complication was an epidural or extradural abscess (84,2%). Regarding PTT therapy, all patients received antibiotic therapy (ATB), and the main empirical antimicrobial scheme used was cephalosporin third generation, with vancomycin and metronidazole. In most cases, surgery was performed using several techniques, mainly an external surgical approach, external drainage (ED) of the subperiosteal abscess associated with endoscopic sinus surgery (ESS). In general, the prognosis is favorable, even if neurological symptoms are present at admission. Conclusion: Based on available literature, PPT is a profoundly serious complication, which can be easily avoided if treated with the ATB, ED and ESS triad immediately, and, if necessary, craniotomy.

scholarly journals Orbital pseudotumor masquerading orbital cellulitis

2021 ◽  
Vol 7 (2) ◽  
pp. 213-216
Author(s):  
Hannah Ranjee Prasanth ◽  
Suriya Djeamourthy ◽  
S. Veni Priya ◽  
Justin Prashanth JP ◽  
Renuka Srinivasan
Keyword(s):  
Rectus Muscle ◽  
Orbital Cellulitis ◽  
High Dose ◽  
Ocular Movements ◽  
Lateral Rectus Muscle ◽  
Oral Steroids ◽  
Dose Oral ◽  
Ocular Pressure ◽  
The Right ◽  
Fat Stranding

Here with presenting a case of pseudotumor orbit initially diagnosed as orbital cellulitis which responded to steroids. A 44 year old male presented with complaints of swelling, redness, watering and inability to open the right eye for 1 day. He had no h/o trauma or insect bite. On examination, visual acuity in both eyes was 6/6. The right eye was proptosed with gross restriction of the extra ocular movements, conjunctival congestion and chemosis. The intra ocular pressure was 52 mm Hg. The left eye was normal. CT orbit showed enlargement of right lateral rectus muscle and lacrimal gland, with fat stranding and soft tissue thickening of periorbital, pre septal and perinasal regions diagnostic of pseudotumor tumour. He was started on high dose oral steroids with which he improved dramatically.

scholarly journals Boxing Match Gone Awry- A Punch over the Head Leading to Eccentric Proptosis in a Child

2021 ◽  
Author(s):  
Gayathri Nithianandam ◽  
S Prabakaran ◽  
Geeta Anusha Loya ◽  
S Rajasekaran ◽  
Premnath Gnaneswaran
Keyword(s):  
Rare Case ◽  
Mass Effect ◽  
Functional Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Normal Position ◽  
Upper Eyelid ◽  
Retinal Tear ◽  
Ocular Movements ◽  
Amateur Boxing ◽  
The Right

The most common ocular pathologic conditions in amateur boxing are sub conjunctival haemorrhage, lid injuries, cataract, pupil deformation, angle abnormalities and retinal tear. Proptosis due to frontoethmoidal mucocele in young is one of the least common complications seen in boxers. Here, we discuss a rare case of unilateral eccentric proptosis of right eye in a child after he was punched over the right side of the head during a boxing match. He came with complaints of swelling of upper eyelid. Examination revealed right sided eccentric proptosis with restricted ocular movements and defective vision. Computed Tomography (CT) of orbit showed a well-defined isodense lesion with smooth margins arising from the frontal sinus, extending inferiorly to anterior ethmoidal sinus which caused mass effect over right eye and ocular muscles which resulted in displacement of the eye ball. Otolaryngologist’s opinion was obtained. Functional Endoscopic Sinus Surgery (FESS) was done. Postoperatively vision improved with no proptosis and eyeball returned to its normal position.

scholarly journals To What Extent Can Orbital Cellulitis Emergency Aspect Influence the Diagnosis of Maxillary Sinus Lymphoma?

2020 ◽  
Vol 2020 ◽  
pp. 1-3
Author(s):  
Yousra Ajhoun ◽  
Ismail Aissa ◽  
Taoufik Abdellaoui ◽  
Yasmine Chaoui Roqai ◽  
Ilias Benchafai ◽  
...  
Keyword(s):  
Maxillary Sinus ◽  
Histopathological Examination ◽  
Treatment Protocol ◽  
Orbital Cellulitis ◽  
Ophthalmological Examination ◽  
Steroid Dependency ◽  
Preseptal Cellulitis ◽  
Non Hodgkin Lymphoma ◽  
Ocular Movements ◽  
Full Remission

We present a case of a 46-year-old woman admitted to the emergency department for acute swelling and erythema of the right eyelid for 3 days. Ophthalmological examination was notable for 10/10, P2 best visual acuity, and inflammatory periorbital edema, without exophthalmia nor extraocular motility disturbance. Intraocular pressure was 14 mmHg and fundoscopic examination was not notable for any abnormality. Preseptal cellulitis diagnosis was made, and oral antibiotherapy was immediately started; after 72 hours, the patient did not improve and started complaining of pain on ocular movements. Brain and orbit MRI scan revealed right retroseptal cellulitis associated with homolateral pansinusitis. Intravenous antibiotherapy with oral corticosteroid was started simultaneously leading to full remission but with steroid dependency; 5 days after finishing prednisone, orbital cellulitis symptoms reappeared. The same treatment protocol was given but with corticosteroid tapering over weeks. Nevertheless, steroid dependency persisted. Except for the inflammatory syndrome, complete biological examinations did not disclose any abnormalities. The patient underwent maxillary sinus and fat orbital biopsy; however, histopathological examination was not contributory. Persistence of steroid dependency, chronic atypical rhinosinusitis, normal paraclinical investigations, and age of patient let us suspect lymphoma origin hidden by chronic corticosteroid. We carried out for the second time a maxillary sinus biopsy after stopping steroids, which disclosed primitive non-Hodgkin lymphoma of the maxillary sinus. The aim of this observation is firstly to evoke though it is exceptional the diagnosis of maxillary lymphoma in case of atypical orbital cellulitis and secondly to incite clinicians to be more vigilant in prescribing corticosteroid even if there is an emergency character of orbital cellulitis.

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