Orbital Complications of Acute Sinusitis in Pediatric Patients: Management of Chandler III Patients
Background Surgery is often avoided in the setting of pediatric orbital complications from acute sinusitis unless necessitated by alarming ophthalmological signs. Criteria for surgical intervention are not well-defined. Objective We aim to review our experiences, management practices and patient out...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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SAGE Publishing
2022-04-01
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| Series: | Allergy & Rhinology |
| Online Access: | https://doi.org/10.1177/21526575221097311 |
| _version_ | 1818249778894471168 |
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| author | Mohamad Z. Saltagi MD Cyrus C. Rabbani MD Kunal S. Patel MD Todd J. Wannemuehler MD Rao V. Chundury MD Elisa A. Illing MD Jonathan Y. Ting MD |
| author_facet | Mohamad Z. Saltagi MD Cyrus C. Rabbani MD Kunal S. Patel MD Todd J. Wannemuehler MD Rao V. Chundury MD Elisa A. Illing MD Jonathan Y. Ting MD |
| author_sort | Mohamad Z. Saltagi MD |
| collection | DOAJ |
| description | Background Surgery is often avoided in the setting of pediatric orbital complications from acute sinusitis unless necessitated by alarming ophthalmological signs. Criteria for surgical intervention are not well-defined. Objective We aim to review our experiences, management practices and patient outcomes over a ten-year period for Chandler III patients. Methods A retrospective review was performed from January 1, 2007 through December 31, 2016 of patients treated for orbital symptoms secondary to acute sinusitis at a free-standing tertiary-care pediatric hospital. Results Of the 186 patients reviewed, 42 Chandler III patients were included. Average age was 82.6 months (SD 50.6) with a slight male predominance (M to F, 1.8 to 1). 27 patients (64.3%) underwent intervention including endoscopic sinus surgery (ESS) with or without orbitotomy. Late surgical intervention (>48hrs from admission) demonstrated significant increase in overall length of stay (LOS) when compared with early surgical intervention and/or medical management (median, 6.9 vs 3.6 vs 3.7 days; p < 0.01). Postoperative LOS was also higher in the late surgery group compared with patients who had surgery within 48 hours of admission, but this did not reach statistical significance [median, 3.8 vs 2.8 days, p= 0.12]. There was no significant difference in overall abscess volume between patients who underwent intervention and those who did not (1019 mm 3 vs 805 mm 3 , p = 0.5), but abscess width ≥ 1.2 cm was associated with higher rates of intervention. An alarming extraocular exam was the most common factor associated with surgical intervention. Conclusion Pediatric subperiosteal orbital abscess may prompt surgical intervention by ESS. An alarming ophthalmologic exam should prompt consideration of early intervention, which may lead to decreased overall and post-operative length of hospital stay. Level of Evidence 4 Meeting Information American Rhinologic Society, Fall National Meeting. Chicago, IL, USA. September 8–9, 2017. |
| first_indexed | 2024-12-12T15:41:54Z |
| format | Article |
| id | doaj.art-a0da60923a4e44cdabe57ee67ba3f1ff |
| institution | Directory Open Access Journal |
| issn | 2152-6567 |
| language | English |
| last_indexed | 2024-12-12T15:41:54Z |
| publishDate | 2022-04-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Allergy & Rhinology |
| spelling | doaj.art-a0da60923a4e44cdabe57ee67ba3f1ff2022-12-22T00:19:53ZengSAGE PublishingAllergy & Rhinology2152-65672022-04-011310.1177/21526575221097311Orbital Complications of Acute Sinusitis in Pediatric Patients: Management of Chandler III PatientsMohamad Z. Saltagi MD0Cyrus C. Rabbani MD1Kunal S. Patel MD2Todd J. Wannemuehler MD3Rao V. Chundury MD4Elisa A. Illing MD5Jonathan Y. Ting MD6 , Indianapolis, IN, USA , Indianapolis, IN, USA Department of Ophthalmology, Indianapolis, IN, USA , Indianapolis, IN, USA Department of Ophthalmology, Indianapolis, IN, USA , Indianapolis, IN, USA , Indianapolis, IN, USABackground Surgery is often avoided in the setting of pediatric orbital complications from acute sinusitis unless necessitated by alarming ophthalmological signs. Criteria for surgical intervention are not well-defined. Objective We aim to review our experiences, management practices and patient outcomes over a ten-year period for Chandler III patients. Methods A retrospective review was performed from January 1, 2007 through December 31, 2016 of patients treated for orbital symptoms secondary to acute sinusitis at a free-standing tertiary-care pediatric hospital. Results Of the 186 patients reviewed, 42 Chandler III patients were included. Average age was 82.6 months (SD 50.6) with a slight male predominance (M to F, 1.8 to 1). 27 patients (64.3%) underwent intervention including endoscopic sinus surgery (ESS) with or without orbitotomy. Late surgical intervention (>48hrs from admission) demonstrated significant increase in overall length of stay (LOS) when compared with early surgical intervention and/or medical management (median, 6.9 vs 3.6 vs 3.7 days; p < 0.01). Postoperative LOS was also higher in the late surgery group compared with patients who had surgery within 48 hours of admission, but this did not reach statistical significance [median, 3.8 vs 2.8 days, p= 0.12]. There was no significant difference in overall abscess volume between patients who underwent intervention and those who did not (1019 mm 3 vs 805 mm 3 , p = 0.5), but abscess width ≥ 1.2 cm was associated with higher rates of intervention. An alarming extraocular exam was the most common factor associated with surgical intervention. Conclusion Pediatric subperiosteal orbital abscess may prompt surgical intervention by ESS. An alarming ophthalmologic exam should prompt consideration of early intervention, which may lead to decreased overall and post-operative length of hospital stay. Level of Evidence 4 Meeting Information American Rhinologic Society, Fall National Meeting. Chicago, IL, USA. September 8–9, 2017.https://doi.org/10.1177/21526575221097311 |
| spellingShingle | Mohamad Z. Saltagi MD Cyrus C. Rabbani MD Kunal S. Patel MD Todd J. Wannemuehler MD Rao V. Chundury MD Elisa A. Illing MD Jonathan Y. Ting MD Orbital Complications of Acute Sinusitis in Pediatric Patients: Management of Chandler III Patients Allergy & Rhinology |
| title | Orbital Complications of Acute Sinusitis in Pediatric Patients: Management of Chandler III Patients |
| title_full | Orbital Complications of Acute Sinusitis in Pediatric Patients: Management of Chandler III Patients |
| title_fullStr | Orbital Complications of Acute Sinusitis in Pediatric Patients: Management of Chandler III Patients |
| title_full_unstemmed | Orbital Complications of Acute Sinusitis in Pediatric Patients: Management of Chandler III Patients |
| title_short | Orbital Complications of Acute Sinusitis in Pediatric Patients: Management of Chandler III Patients |
| title_sort | orbital complications of acute sinusitis in pediatric patients management of chandler iii patients |
| url | https://doi.org/10.1177/21526575221097311 |
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