Studying the level of awareness of Russian and foreign dental students about orbital complications in dental pathology

The article analyzes the level of awareness of dental students about the occurrence of orbital pathology as a result of infection in the oral cavity. Anonymous survey of 4-5 year students of the Institute of Dentistry was carried out. 128 people took part in the survey. To conduct a comparative study, we used the data of foreign colleagues, who also asked graduates of the educational institution to answer similar questions (140 people). The questions presented in the questionnaire characterize general ideas about the possibility of developing orbital complications, as well as the tactics of a dentist in case of ocular complications in a dental infection. Most of the respondents stated the need for additional information, conducting reviews on the development of ocular complications in dental infection. Key words: orbital complications, questionnaires, opinion of dental students.

The Diagnostic Value of the Leukocyte Shift Index in Purulent-Septic Rhinosinusogenic Complications in Children

The aim of this study was to investigate the diagnostic value of the leukocyte shift index (LSI) in inflammatory pathology of the paranasal sinuses (PNS) with the rhinosinusogenic orbital complications (RSOC) in pediatric patients. Methods and Results: The study involved 50 patients (26 boys and 24 girls) with diseases of the PNS and RSOC (reactive edema of the eyelids, orbital tissue, and purulent-septic complications of the eyelids and orbit) aged from 1 to 17 years (mean age of 6.66±0.63 years). Group 1 included 29 patients (16 boys and 13 girls) with reactive edema of the eyelids and orbital tissue. Group 2 included 21 patients (10 boys and 11 girls) with purulent-septic RSOC. As a marker for determining the activity of the inflammatory process and the disorders of the immunological reactivity of the body, LSI (leukocyte shift index) was calculated. In general, the LSI value was 1.61±0.21 in Group 1 and 3.45±0.49 in Group 2 (P=0.001). Among patients aged between 3 and 12 years, the LSI was 1.66±0.30 in Group 1 and 3.93±0.79 in Group 2 (P=0.012). The results obtained indicate that LSI can be used to predict purulent-septic RSOC in inflammatory diseases of PNS in patients aged between 3 and 12 years. LSI values from 1.36 to 1.96 may predict the development of reactive edema of the eyelids and orbital tissue; from 3.14 to 4.72 - the development of purulent-septic complications of the eyelids and orbit. Conclusion: The results obtained can be useful in predicting the clinical course of the RSOC in inflammatory pathology of PNS in patients in the age group of 3-12 years.

Functional Endoscopic Orbital Decompression Surgery in Acute Rhinosinusitis with Orbital Complication : A Case Report

<div class="WordSection1"><p><strong>Introduction: </strong>Orbital complications secondary to acute rhinosinusitis can cause permanent vision loss and death if not treated promptly and appropriately. The prevalence of orbital complications due to rhinosinusitis is more common in children than adults, occurring in 3-4% of children with acute rhinosinusitis. Lamina papyracea in children has many dehiscences, the nasal cavity tends to be narrower and the mucosa is softer than in adults, therefore causing the spread of infection more easily from the sinuses to the eyes. Clinical presentation: a 4-year-old child presented with eye swelling and pus discharge in the right eye for 5 days before being admitted to the hospital, for which she was treated with medication and did not improve. On physical examination, there is a narrow nasal cavity, inferior turbinate edema, and hyperemia, mucopurulent discharge. CT scan and MRI revealed contrast enhancement in intraorbital with suspected intraorbital abscess with orbital cellulitis, right pansinusitis, and buccal abscess. Functional endoscopic orbital decompression was done immediately.</p><p><strong>Conclusion: </strong>Orbital complications due to acute rhinosinusitis are uncommon but potentially lead to more fatal complications. Early diagnosis and aggressive treatment of immediate functional endoscopic sinus surgery and antimicrobial therapy have a good outcome.</p></div>

Invasive Fungal Rhinosinusitis with and without Orbital Complications: Clinical and Laboratory Differences

Background: Invasive fungal rhinosinusitis (IFS) is a rare but often fatal disease. There are limited studies regarding IFS with orbital complications (IFSwOC). The present study aimed to identify the clinical signs associated with IFSwOC and prognosticators of the disease. Methods: A retrospective case series was conducted of patients histopathologically confirmed IFS or fungal rhinosinusitis with clinically apparent neuro-orbital complications who underwent surgery between 2008 and 2018. Demographic data, presenting symptoms and signs, culture data, laboratory results, and patient outcomes were obtained from medical records. Results: A total of 38 patients were identified, including 9 patients with IFSwOC, and 29 patients with IFS without orbital complications (IFSsOC). The clinical signs associated with developing orbital complications include headache, fever, sphenoid sinus, or posterior ethmoid sinus involvement, CRP level ≥ 1.025 mg/dL, or ESR level ≥ 46.5 mm/h. In IFSwOC group, male, posterior ethmoid sinus involvement, WBC count ≥ 9000 μL, CRP level ≥ 6.91 mg/dL, or ESR level ≥ 69 mm/h were correlated with a significantly poorer prognosis. Conclusion: IFS patients with sphenoid or posterior ethmoid sinus involvement, headache or fever as presenting symptoms, elevated CRP, and ESR level were at risk of developing orbital complications. Timely surgical debridement followed by systemic antifungal treatment may improve treatment outcomes.

Multi-Modality Imaging of Craniofacial Fibrous Dysplasia with Orbital Complications and Histopathology Correlation-A case report and short review of literature

Craniofacial fibrous dysplasia [CF-FD] with orbital complications is a known but rare entity. This is a multi-modality imaging Case Report of extensive CF-FD in a 31-year-old male with right eye pain, swelling, and redness, along with histopathology correlation. In this patient, the CT scan demonstrates the classic ground glass bony appearance in great detail and helps with the diagnosis of FD, while excluding other bony pathology. The patient’s corroborative MRI brain with and without contrast and MRI brain perfusion images are presented to further characterize this pathology along with its orbital and ocular complications. Given the significant mass-effect on the ocular structures, the patient underwent orbital surgery with removal of as much of the lesion as possible. On macroscopic pathology evaluation, the affected bone was rubbery and gritty when sectioned. Microscopically, remnant fragments of woven bone of various size and shapes were seen with lack of an osteoblast rim. The bony fragments had a characteristic curvilinear, trabecular, and/or branching pattern. Post-surgical imaging demonstrated improvement in the mass-effect on orbital structures and proptosis, along with residual bony lesion.

Diagnosis and Management of Orbital Fat Exposure During Endoscopic Sinus Surgery

Background: The orbital complication rate during endoscopic sinus surgery (ESS) is <1%. Orbital fat exposure during ESS can herald orbital complications including orbital hematoma, extraocular muscle trauma, optic nerve injury, or blindness. The objective of this study was to evaluate the current consensus regarding diagnosis and management of orbital fat exposure during ESS. Methods: A 24-point survey focused on orbital fat exposure during ESS was distributed to American Rhinologic Society members. Also, a retrospective review of 25 cases of orbital fat exposure drawn from the principal investigator’s 30-year experience was performed. Results: Over 10 000 surgical cases of the principal investigator were reviewed. Twenty-five patients had orbital fat exposure. Five developed minor complications while 2 were major (ie, temporary vision changes). Two hundred thirty-six surgeons responded to the survey; 93% had encountered orbital fat during ESS; 88% of surgeons identify orbital fat by either its appearance endoscopically or the “bulb press” test. Almost every responding surgeon will cautiously avoid further manipulation in the area of orbital fat exposure. Nearly half will immediately curtail the extent of surgery. Surgeons do not significantly change postoperative management. Considerations regarding observation in postanesthesia care unit, close follow-up, and strict nose blowing precautions are common. Conclusion: Orbital fat exposure during ESS is a rarely discussed, but clinically important. Orbital fat exposure can be a harbinger for major orbital complications that should be recognized by endoscopic appearance and confirmed with the bulb press test. Caution with “no further manipulation” of orbital fat is the guiding principle for intraoperative management, while postoperative management is generally expectant. Level 4 Evidence