Conservative treatment in rhinosinusitis orbital complications in children aged 2 years and younger

Objective: Orbital complications (OC) secondary to acute rhinosinusitis (ARS) in children are uncommon, but can result in severe morbidity and mortality if not treated appropriately. These complications are more common in older children. We evaluate the disease and its management in children aged 2 and under. Material and methods: Fifty-two records of children aged 2 and younger with OC secondary to ARS between 1993 and 2002 were reviewed retrospectively. Parameters recorded included age, gender, clinical symptoms and signs, CT findings, duration of hospitalization, treatment before and during admission, cultures and outcome. Results: Forty-eight children were diagnosed with periorbital cellulitis, 4 with subperiosteal abscess and none with orbital abscess or cavernous sinus thrombosis. All were managed conservatively except I who underwent surgery. CT scan performed in 8 children revealed sinusitis in only 7. Average length of hospitalization was 3.6 days for preseptal cellulitis and 65 for postseptal cellulitis. Conclusion: SOC secondary to ARS mandates meticulous multidisciplinary follow-up in hospital. CT scan and surgery are indicated in cases of ophthalmoplegia, proptosis, decreased visual acuity or failure of conservative treatment within 48 hours. However, most children aged 2 and younger respond well to conservative treatment and no surgical intervention is required.