[Orbital complications of acute pediatric rhinosinusitis: medical treatment versus surgery and analysis of the computer tomogram].
BACKGROUND
One of the most common complications of acute pediatric rhinosinusitis is orbital complication. For subperiosteal abscess, in particular, there are no generally accepted therapy recommendations.


METHODS
A retrospective study of 45 children with acute orbital rhinosinusitis complications, treated on an in-patient basis at the Department of ENT, Inselspital, University of Bern (1999-2004) is presented. The aim was to analyze conservative medical versus surgical treatment with regard to the individual stages of complications (according to the classification of Moloney, 1987) and, subsequently, to arrive at a therapy recommendation.


RESULTS
All children with preseptal cellulitis (stage I), 80 % of children with radiological a subperiosteal phlegmona (Stage IIA) and 67 % of the children with radiological a subperiosteal abscess (Stage IIB) could be treated conservatively. The child with the orbital cellulitis (Stage III) was treated surgically.


CONCLUSIONS
The preseptal cellulitis can be treated conservatively. We recommend an initial conservative therapy of 24 - 48 hours for subperiosteal phlegmona and subperiosteal abscess in the presence of normal vision. Surgical intervention should take place only if there is no improvement after this time interval. The orbital cellulitis should be treated primary surgically.
Caversaccio
M
M
Universitätsklinik für HNO, Hals- und Gesichtschirurgie, Bern. marco.caversaccio@insel.ch
Heimgartner
S
S
Aebi
C
C
D000038:Abscess / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D000208:Acute Disease; D000293:Adolescent; D002481:Cellulitis / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009916:Orbital Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D010043:Outcome and Process Assessment, Health Care; D010521:Periosteum / Q000000981:diagnostic imaging / Q000601:surgery; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D012189:Retrospective Studies; D012220:Rhinitis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D012852:Sinusitis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D036542:Tomography, Spiral Computed