Meeting abstract
Orbital cellulitis as a vfirst sign of ethmoid sinus osteoma in children - case report and short literature review
Filip Tudor
orcid.org/0000-0001-6386-0444
; Rijeka clinical hospital center, Department of otorhinolaryngology, head and neck surgery; University of Rijeka, Faculty of medicine, Rijeka, Croatia
Dubravko Manestar
; Rijeka clinical hospital center, Department of otorhinolaryngology, head and neck surgery; University of Rijeka, Faculty of medicine, Rijeka, Croatia
Tamara Braut
; Rijeka clinical hospital center, Department of otorhinolaryngology, head and neck surgery; University of Rijeka, Faculty of medicine, Rijeka, Croatia
Abstract
Introduction: Orbital cellulitis is a rare condition with very dangerous complication of acute sinus
infection that could potentially lead to vision loss. It is the most common complication of acute sinusitis,
especially in children. On the other hand, osteoma of paranasal sinuses in pediatric patients causing orbital
cellulitis is a very rare phenomenon.
Case report: A 13-year-old male child was presented to our Clinic with severe frontal headache, large
swelling of the upper right eyelid, proptosis, chemosis and impaired vision of the affected eye. Fiberendoscopy
showed purulent discharge from both nasal cavums and mucosal inflammation which caused the narrowing of
the right ostiomeatal complex as well as sphenoetmoidal recess. Computer tomography of the paranasal sinuses
revealed a subperiosteal abscess localized on the superolateral orbital wall with opacified right frontal sinus
and huge ethmoid sinus osteoma measuring 2.5x2x1 cm. The tumour was removed endoscopically and great
care was taken not to pierce the skull base and simultaneously remove all parts of the tumour. In addition, an
outer incision of 1 cm of the upper eyelid was performed. The patient’s symptoms decreased postoperatively,
and the patient was released from the Clinic with significant improvement on the sixth postoperative day.
Discussion: We present an extremely rare case of ethmoidal osteoma which caused orbital cellulitis in
a pediatric patient. Treating such patients is very sensitive and established algorithms do not exist. We
examined the available literature on the aforementioned topic. According to Chandler’s classification of orbital
cellulitis, the treating of grade III or subperiosteal abscess is still a controversy. However, in our patient’s case,
the cause of cellulitis was large osteoma, so surgical intervention was inevitable. An endoscopic approach
gives excellent results, but maximal care must be taken in order to avoid damaging the surrounding important
structures, especially in pediatric patients who have narrow nasal cavities.
Keywords
orbital cellulitis; ethmoid sinus osteoma; pediatrics
Hrčak ID:
272982
URI
Publication date:
27.2.2022.
Visits: 501 *