Acute Invasive Fungal Rhinosinusitis-Related Orbital Infection: A Single Medical Center Experience

Backgrounds. Acute invasive fungal rhinosinusitis (AIFRS) is a hazardous infectious disease with rapid progression and high mortality and morbidities. Further orbital involvement is commonly seen. This study aims to analyze risk factors, clinical characteristics, and outcomes between patients with or without orbital involvement. Methods. A retrospective review was performed in a single tertiary medical center over a span of 13 years (2005–2018). A total of 21 patients with diagnosis of AIFRS were enrolled. We reviewed the patients’ basic characteristics, comorbidities, clinical presentations, image study findings, culture pathogens, and treatment outcomes and analyzed the differences between orbital-involved and orbital sparing disease. Results. The most common comorbidities in AIFRS were diabetes mellitus (DM) and hematological malignancy. Nine the 21 AIFRS patients had orbital-involved disease. Patients with orbital involvement had a higher prevalence of DM ( p < 0.05 ). Image studies revealed significant infection of the ethmoid sinus, sphenoid sinus, and frontal sinus in the group with orbital complication ( p < 0.05 ). Mucor, Rhizopus, and Aspergillus were cultured in both groups. Five patients in the orbital involvement group expired, with all of them having an initial presentation of conscious disturbance ( p < 0.01 ). Rhino-orbital-cerebral fungal infection was noticed in 3 of the 5 expired patients. Conclusion. In AIFRS patients, DM other than hematological malignancy was the main risk factor for orbital-involved disease. Patients with ethmoid, sphenoid, or frontal sinusitis had a higher possibility of orbital complication. Poor consciousness at initial presentation revealed highest possibility of rhino-orbital-cerebral fungal infection and led to death.

Orbital Abscess Drainage Using Intravenous Cannula: Technique and Advantages

The orbital infections are known to be the most frequent primitive orbital pathology. Rhinosinusitis (RS) is the most common cause of orbital inflammation and infection, especially in the pediatric range. So far, the main orbital complication of RS is the preseptal cellulitis. The dissemination of the infection in the orbital retroseptal area may occur and is considered to be a serious complication requiring urgent diagnosis and treatment. It is usually seen as an orbital (OSPA) subperiosteal abscess adjacent to the infected sinus. The diagnosis of an OSPA is based on clinical evaluation as well as X-ray imaging. The CT scan is the preferred imaging modality for orbital abscess diagnosis. In most cases of OSPA, the surgery is often indicated and can be conducted by an external method, transnasal endoscopy or a combined method. In this article, we describe the technique of external drainage using an intravenous cannula (case report of 10 patients) as well as the results obtained.

A descriptive study of the patients with orbital complication of acute and chronic sinusitis

<p class="abstract"><strong>Background:</strong> This is a descriptive study of all of the patients with orbital complication of acute and chronic sinusitis presented in ENT and Ophthalmology department, Government Medical College Calicut, Kerala from January 2013 to September 2014. The purpose of this study is to evaluate clinical and radiological presentation, outcome of treatment and postsurgical complications of diagnosed case of orbital complications of acute and chronic sinusitis.</p><p class="abstract"><strong>Methods:</strong> All the patients were subjected to thorough clinical examination, ophthalmological evaluation and radiological evaluation. Computerized tomography of paranasal sinuses both axial and coronal planes, MRI in selected cases, histopathology, fungal culture, a semistructured proforma are the study tools in this study. All the patients in this study received appropriate medical and surgical treatment and done a follow up evaluation at first month and at 3 months. </p><p class="abstract"><strong>Results:</strong> Preseptal cellulitis is the most common complication in our study. Fungal sinusitis due to uncontrolled diabetes mellitus is the most common condition causing orbital complication in our study.</p><p class="abstract"><strong>Conclusions:</strong> Strict diabetic control, appropriate surgical and medical management and a vigilant follow up resulted in good outcome.</p>