Pediatric orbital cellulitis: Case report of an unusual etiology and pathogen

2022 ◽  
pp. 014556132110640
Author(s):  
Wen Chao Daniel Chew ◽  
James Wei Ming Kwek ◽  
Rosslyn Anicete ◽  
Mei-yi Low
Keyword(s):  
Needle Aspiration ◽  
Orbital Cellulitis ◽  
Sinus Surgery ◽  
Facial Trauma ◽  
Local Pressure ◽  
Streptococcus Constellatus ◽  
Parvimonas Micra ◽  
Vascular Congestion ◽  
Direct Inoculation ◽  
Uncommon Condition

Orbital cellulitis is an uncommon condition with risks to sight and life. As a complication of maxillofacial injuries, the literature suggests this is only possible with fractures or direct inoculation, and there are no reports to the contrary. Here, we make the first report of a possible etiology by which orbital cellulitis developed in a 14-year-old boy even without skin breach or bony fractures; as well as a rare causative pathogen. He presented with facial abscess and progressive orbital cellulitis after blunt facial trauma, requiring functional endoscopic sinus surgery with needle aspiration of facial abscess externally. Cultures showed growth of Streptococcus constellatus/Parvimonas micra, and he received further antibiotics with full recovery. The pathophysiology of orbital cellulitis in this patient is attributed to vascular congestion and local pressure from maxillofacial contusion and maxillary hemoantrum, with impaired paranasal sinus ventilation encouraging anaerobic bacterial growth. Further progression led to facial abscess formation and intraorbital spread with orbital cellulitis. The pediatric demographic is injury-prone, and self-reporting of symptoms can be delayed. Hence, increased suspicion of complicated injuries and orbital cellulitis may be required when managing maxillofacial contusions so that prompt treatment can be given.

scholarly journals Comparative In Vitro Resistance of Human Periodontal Bacterial Pathogens to Tinidazole and Four Other Antibiotics

Antibiotics ◽  
2020 ◽  
Vol 9 (2) ◽  
pp. 68 ◽  
Author(s):  
Thomas E. Rams ◽  
Jacqueline D. Sautter ◽  
Arie J. van Winkelhoff
Keyword(s):  
Fusobacterium Nucleatum ◽  
Periodontal Pathogens ◽  
Test Species ◽  
Campylobacter Rectus ◽  
Resistant Species ◽  
Streptococcus Constellatus ◽  
Parvimonas Micra ◽  
Severe Periodontitis ◽  
Resistant Strains

The in vitro resistance of selected red/orange complex periodontal pathogens to tinidazole was compared with four other antibiotics. Subgingival biofilm samples from 88 adults with severe periodontitis were anaerobically incubated on enriched Brucella blood agar with and without supplementation with tinidazole (16 mg/L), metronidazole (16 mg/L), amoxicillin (8 mg/L), doxycycline (4 mg/L), or clindamycin (4 mg/L). Growth of Porphyromonas gingivalis, Tannerella forsythia, Prevotella intermedia/nigrescens, Parvimonas micra, Fusobacterium nucleatum, Streptococcus constellatus, or Campylobacter rectus on antibiotic-supplemented plates indicated their in vitro antibiotic resistance. Tinidazole inhibited all test species, except P. intermedia/nigrescens, P. micra, and S. constellatus in 3.8%, 10.2%, and 88.9% of species-positive patients, respectively. Significantly fewer patients yielded tinidazole-resistant test species, and had significantly lower subgingival proportions of tinidazole-resistant organisms, than patients with amoxicillin, doxycycline, or clindamycin-resistant species, but not those with metronidazole-resistant strains. Joint in vitro species resistance to tinidazole and amoxicillin, or metronidazole and amoxicillin, was rare. Tinidazole performed in vitro similar to metronidazole, and markedly better than amoxicillin, doxycycline, or clindamycin, against fresh clinical isolates of red/orange complex periodontal pathogens. As a result of its similar antimicrobial spectrum, and more convenient once-a-day oral dosing, tinidazole should be considered in place of metronidazole for systemic periodontitis drug therapy.

scholarly journals Blowout fracture-associated orbital cellulitis progressing to panophthalmitis: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Atsuhide Takesue ◽  
Yosuke Asada ◽  
Hiroki Ooya ◽  
Toshiyuki Yokoyama
Keyword(s):  
Ocular Surface ◽  
Corneal Ulcer ◽  
Chronic Sinusitis ◽  
Orbital Cellulitis ◽  
Blowout Fracture ◽  
Obligate Anaerobic ◽  
Parvimonas Micra ◽  
Chronic Periodontal Disease ◽  
The Right ◽  
Head Computed Tomography

Abstract Background Parvimonas micra is known as a causative agent of chronic periodontal disease. This Gram-positive obligate anaerobic coccus was cultured from the ocular surface of blowout fracture-related orbital cellulitis progressing to panophthalmitis. Case presentation The patient was a woman in her fifties who had panic disorder and subsequently was a victim of domestic violence. These factors led to delayed consultation. At the initial visit to an ophthalmologist, the ocular surface of the right eye was covered with pus. Swelling of the upper and lower eyelids prevented the eyelid from closing and exophthalmos, severe corneal ulcer, panophthalmitis, and no light perception were observed. Head computed tomography revealed an old blowout fracture and chronic sinusitis with orbital cellulitis. P. micra were isolated from culture of pus samples from the sinus and from the ocular surface. Conclusions There is a possibility that P. micra invaded the orbit via the fragile bony site and caused orbital cellulitis, severe corneal ulcer, and panophthalmitis that required enucleation. In cases of coexisting old blowout fracture and chronic sinusitis, the chronic sinusitis should be treated as quickly as possible.

Traumatic orbital ligament avulsion diagnosed with cross-sectional imaging in three dogs

2020 ◽  
Vol 8 (3) ◽  
pp. e001143
Author(s):  
Emilie M Hanot ◽  
David L Williams ◽  
Abby Caine
Keyword(s):  
Surgical Intervention ◽  
Specific Treatment ◽  
Linear Structure ◽  
Facial Trauma ◽  
Visual Axis ◽  
Cross Sectional ◽  
Zygomatic Process ◽  
Frontal Process ◽  
Cross Sectional Imaging ◽  
Uncommon Condition

The aim of the study was to describe the clinical and imaging findings of three dogs diagnosed with orbital ligament avulsion. Three immature dogs presented following a facial bite trauma, including multiple skull fractures and ventral, ventrolateral or rostrolateral displacement of the affected eye. The extent of lesions and orbital ligament avulsion were assessed and diagnosed using CT (n=2) or MRI (n=1). Orbital ligament avulsion was identified as an interruption of the linear structure between the zygomatic process of the frontal bone and the frontal process of the zygomatic bone. One dog was treated surgically to correct a visual axis alteration, while the remaining two dogs were managed conservatively. Orbital ligament avulsion is an uncommon condition that should be considered following a facial trauma. Concurrent lesions might necessitate surgical intervention, but it remains unclear if the avulsion of the orbital ligament itself requires a specific treatment.

Studies on mucocoeles of the ethmoid and sphenoid sinuses: Analysis of 47 cases

1992 ◽  
Vol 106 (1) ◽  
pp. 23-27 ◽  
Author(s):  
Hiroshi Moriyama ◽  
Tsuneya Nakajima ◽  
Yoshio Honda
Keyword(s):  
Young Patients ◽  
Visual Disturbance ◽  
Sinus Surgery ◽  
Facial Trauma ◽  
Surgical Wound ◽  
Initial Surgery ◽  
Paranasal Sinus Surgery ◽  
Orbital Pain ◽  
History Of ◽  
Sphenoid Sinuses

AbstractForty-seven mucocoeles of the ethmoid and/or sphenoid sinuses (33 males, 14 females) were operated on during the 10-years period from 1980 through 1989. Thirty-seven cases were post-operative mucocoele, while the remaining 10 were so-called primary mucocoeles. None of the cases had a history of facial trauma. In the majority of post-operative cases, the mucocoele develops 15–24 years after initial surgery. Paranasal sinus surgery in young patients (teenagers) may lead to a mucocoele due to post-operative scarring in the surgical wound. The principal symptoms include globe displacement, double vision, headache, deep orbital pain, a mass in the supero-medial quadrant of the orbit, visual disturbance, etc. Sufficient opening of the mucocoele wall by the endonasal approach is recommended for surgical treatment of ethmoidal and sphenoidal mucocoeles

scholarly journals FOREIGN BODY IN MAXILLARY SINUS WITH SKIN FISTULA – CLINICAL CASE

2019 ◽  
Vol 6 (3) ◽  
pp. 82-84 ◽  
Author(s):  
Daniela Vrînceanu ◽  
M. Dumitru ◽  
B. Banica ◽  
Adriana Nica
Keyword(s):  
Foreign Body ◽  
Ct Scan ◽  
Maxillary Sinus ◽  
Head Trauma ◽  
Clinical Case ◽  
Sinus Surgery ◽  
Facial Trauma ◽  
Legal Implications ◽  
Left Maxillary Sinus ◽  
Skin Fistula

We present the case of a 41 years old patient with poor social status and previous facial trauma with a sharp object (wood branch) 2 years ago. Although it was performed the extraction of the branch in a local ENT department, the patient developed a fistula in the left genian region with the presence of puss. Two months ago the patient undergoes another head trauma leading to neurosurgery. CT scan raises the suspicion of a foreign body in the left maxillary sinus. We performed left maxillary sinus surgery through Caldwell-Luc approach with extraction of the foreign body and closure of the fistula. Surgical healing was optimal within 10 days. We analyze the medico-legal implications of such cases.

scholarly journals Application of Viscoelastic testing to the field of Otolaryngology Head and Neck Surgery: A Scoping Review

2020 ◽  
Vol 3 ◽  
Author(s):  
Faisal Shariff ◽  
Mathew Marsee ◽  
Mark Walsh
Keyword(s):  
Head And Neck ◽  
Free Flap ◽  
Scoping Review ◽  
Neck Surgery ◽  
Head And Neck Surgery ◽  
Sinus Surgery ◽  
Facial Trauma ◽  
Blood Component ◽  
Inclusion Criteria ◽  
Obstructive Sleep

Background:  In Otolaryngology Head and Neck Surgery (OHNS), hematologic management requires attention to the intricate nature of hemostatic competence. Elderly patients can experience drug induced coagulopathies. Strategies are needed in order to minimize hemorrhagic and thromboembolic risk and maximize positive outcomes. Viscoelastic tests (VETs) such as Thromboelastography (TEG) and Rotational Thromboelastometry (ROTEM) have been used to guide blood component therapy. The purpose of this scoping review is to understand the utilization of VETs in OHNS.    Methods:     This scoping review included studies that discussed the utilization of VETs in the field of OHNS. The inclusion criteria was studies that discussed the application of VETs in Flap/Plastic Reconstruction, Facial Trauma/Resuscitation, Tonsillectomy, Obstructive Sleep Apnea (OSA), Epistaxis, Sinus Surgery, and HNC Resection. Studies that focused on general medical VET use were not included.    Results:    Fourteen articles met the study inclusion criteria from an initial pool of 45 articles. Seven articles discussed the use of VETs in free flap/reconstructive surgery, five articles explored use in HNC, two articles discussed use in facial trauma and resuscitation, one article mentioned use in OSA, and one article examined use in epistaxis.     Conclusion and potential impact:    Of the fourteen articles included, two articles found no clinically significant association between TEG parameters and flap loss or complications. Five studies found that TEG or ROTEM helpful in predicting coagulation clotting, a prothrombotic state, or a hyperfibrinolytic state in free flap and HNC patients. For facial trauma and HNC cancer patients two different studies found ROTEM helpful in guiding blood component resuscitation. Using the TEG, one study demonstrated a hypercoagulable state in OSA patients. This review encourages wider use of VETs in OHNS in order to monitor hemostasis and improve surgical outcomes. Further research is necessary to better understand how VETs can tailor hematologic management of OHNS patients. 

Auricular pseudocyst in the tropics: a multi-racial Singapore experience

2004 ◽  
Vol 118 (3) ◽  
pp. 185-188 ◽  
Author(s):  
B. Y. B. Tan ◽  
P. P. Hsu
Keyword(s):  
Large Scale ◽  
Anterior Wall ◽  
The Other ◽  
Local Pressure ◽  
Chinese Populations ◽  
Pressure Application ◽  
Epidemiological Features ◽  
History Of ◽  
Uncommon Condition ◽  
The Tropics

Endochondral pseudocyst of the auricle is an uncommon condition that affects predominantly Chinese males, with many reports studying this condition in homogenous Chinese populations. There have been few large-scale reports describing the features of this disease among the other Asian groups. In one of the largest series described to date, we report the epidemiological features, clinico-pathologic characteristics, and success of surgical treatment in 40 patients of different Asian groups presenting with pseudocyst of the auricle. Results showed a Chinese predominance (90 per cent), followed by Malays (five per cent) and Eurasians (five per cent). All had unilateral presentations apart from one patient. Most (55 per cent) presented within two weeks of auricular swelling. Few (10 per cent) had a history of trauma. The pseudocysts predominantly affected the concha (61 per cent). Surgery comprised excision of the anterior wall followed by local pressure application. Only 2.5 per cent had recurrence after surgery. These findings confirm earlier understood features of this disease while revealing some notable variations.

scholarly journals Medical And Surgical Management Of Orbital Cellulitis In Children

Folia Medica ◽  
2014 ◽  
Vol 56 (4) ◽  
pp. 253-258 ◽  
Author(s):  
Ronit Friling ◽  
Ben-Zion Garty ◽  
Liora Kornreich ◽  
Oded Scheurman ◽  
Murat Hasanreisoglu ◽  
...  
Keyword(s):  
Surgical Intervention ◽  
Medical Center ◽  
Clinical Signs ◽  
Orbital Cellulitis ◽  
Sinus Surgery ◽  
Older Children ◽  
Ocular Pain ◽  
Factors Associated ◽  
Treatment Comparison ◽  
Patients At Risk

Abstract Objective: The purpose of this study was to identify features of orbital cellulitis that predict response to conservative treatment without surgical intervention and factors associated with a decision for surgery. Patients and Methods: The medical files of patients diagnosed with orbital cellulitis at a tertiary medical center in central Israel between 1995 and 2010 were reviewed for clinical data, diagnosis, complications, and type of treatment. Comparison was made between patients treated with antibiotics and patients treated with antibiotics and surgery. Results: Fifty-one patients (35 male) with a mean age of 6.1 years were identified. Main clinical signs included fever (mean 38.5°C), proptosis (82.3%), extraocular motility restriction (74.5%), and ocular pain (41.1%). Forty-one patients were successfully treated with antibiotics and 10 required endoscopic sinus surgery. On between-group comparison, the surgery group had severe eye pain (p = 0.009), severe proptosis (P = 0.02), longer intravenous antibiotic treatment (13.2 vs. 9.2 days, p = 0.04), and several imaging findings. Additional factors associated with surgical intervention included older children, subperiorbital abscess, larger dimension of the abscess (mean 15 mm), involvement of frontal sinuses and findings of intraorbital air bubbles. There was no visual deterioration in either group and no late sequelae. Conclusion: Factors associated with surgery included age older than 9 years, severe ocular pain, severe proptosis, and subperiorbital large abscess. These may be used for early identification of patients at risk of failure of only medical management.

Orbital Complications of Rhinosinusitis in the Adult Population: Analysis of Cases Presenting to a Tertiary Medical Center Over a 13-Year Period

2019 ◽  
Vol 128 (6) ◽  
pp. 563-568 ◽  
Author(s):  
Aiman El Mograbi ◽  
Amit Ritter ◽  
Esmat Najjar ◽  
Ethan Soudry
Keyword(s):  
Chronic Rhinosinusitis ◽  
Cavernous Sinus ◽  
Sinus Thrombosis ◽  
Orbital Cellulitis ◽  
Sinus Surgery ◽  
Cavernous Sinus Thrombosis ◽  
Surgical Drainage ◽  
Acute Rhinosinusitis ◽  
Orbital Wall ◽  
Orbital Complications

Background: Orbital complications of rhinosinusitis in adults are scarcely discussed in the literature. Objective: To review our experience with the management of orbital complications of rhinosinusitis in the adult patient population and identify key factors in the characteristics and management of these patients. Design: Retrospective case series during the years 2004 to 2016 in a tertiary referral center including all patients with rhinosinusitis and orbital complications. Main Outcomes and Measures: Severity of complications, risk factors, clinical, imaging and microbiological data, treatment outcomes. Results: Seventy patients were identified. Median age at diagnosis was 38 years. In 57%, complications were associated with acute rhinosinusitis and in 43% with chronic rhinosinusitis, most of whom had a history of previous sinus surgery. Thirty-five percent of patients received antibiotics prior to admission. The majority of the previously operated patients (61%) had some form of orbital wall dehiscence noted on imaging. Preseptal cellulitis was the most common complication (61.5%) encountered, followed by orbital cellulitis (23%), sub-periosteal abscess (11.5%), orbital abscess (3%), and cavernous sinus thrombosis (1.5%). Gram-positive bacteria were more commonly isolated from acute rhinosinusitis patients and gram-negative bacteria from chronic rhinosinusitis (CRS) patients. Complete recovery was noted in all patients, of whom 85% were managed conservatively. All, but 1 patient, with an abscess or cavernous sinus thrombosis required surgical drainage. Older age was the only risk factor identified for severe complications. Conclusions: In contrast to the pediatric population, CRS is very common in adults with orbital complications of rhinosinusitis, with previous sinus surgery and orbital wall dehiscence being noticeably common. Older patients are at risk for more severe complications. Conservative treatment suffices in patients with preseptal and orbital cellulitis. In more advanced stages, surgical drainage is advocated with excellent results. Larger cohort studies are needed to further investigate this patient group.

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