Emergency endoscopic sinus surgery in pediatric complicated sinusitis: case insights and current evidence

Malak Alamoudi; Aisha A. Bubshait; Hatem I. Al Ali; Maria R. Alabdulaal; Ali Almomen

doi:10.18203/issn.2454-5929.ijohns20260067

Authors

Malak Alamoudi Department of Otolaryngology-Head and Neck Surgery, King Fahad Specialist Hospital, Dammam, Saudi Arabia
Aisha A. Bubshait Department of Family medicine, Al Ahsa cluster, Saudi Arabia
Hatem I. Al Ali Department of Emergency medicine, Second health cluster, Riyadh, Saudi Arabia
Maria R. Alabdulaal Department of Otolaryngology-Head and Neck Surgery, Al Jabr Eye and ENT Hospital, Al Ahsa, Saudi Arabia
Ali Almomen Department of Otolaryngology-Head and Neck Surgery, King Fahad Specialist Hospital, Dammam, Saudi Arabia

DOI:

https://doi.org/10.18203/issn.2454-5929.ijohns20260067

Keywords:

Orbital complications, Endonasal endoscopic surgery, Rhinosinusitis, Pediatrics, Case series

Abstract

Rhinosinusitis is an inflammation of the lining membranes of the nose and sinuses. Complications of rhinosinusitis, such as orbital and intracranial sepsis, are common in pediatric patients, which can be life-threatening if diagnosis and treatment are delayed. In this case series, we illustrate the emergency indications of functional endoscopic sinus surgery (FESS) in complicated rhinosinusitis in children diagnosed and treated at a tertiary hospital in Saudi Arabia. Three different cases of complicated rhinosinusitis with intraorbital and intracranial extension, including orbital abscess, invasive fungal granulomatous sinusitis with orbital extension, and optic nerve and frontal empyema secondary to frontal sinusitis. All cases were managed by a combination of medical treatment in the form of intravenous (IV) antibiotics and an urgent surgical debridement through functional endoscopic sinus surgery FESS to clean the sinuses, orbit, and brain. Postoperative CT scans confirmed no intraoperative or postoperative complications in all cases. Despite the wide use of antibiotics, the serious complications of sinusitis in children still exist. The management of such cases is usually through a combination of medical and surgical treatments. FESS in the pediatric population is a direct, safe, and practical approach in dealing with the serious complication of pediatric sinusitis with low morbidity and excellent outcomes.

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References

Ah-See KW, Evans AS. Sinusitis and its management. BMJ. 2007;334(7589):358-61. DOI: https://doi.org/10.1136/bmj.39092.679722.BE

Wald ER. Sinusitis in children. N Engl J Med. 1992;326(5):319-23. DOI: https://doi.org/10.1056/NEJM199201303260507

American Academy of Pediatrics, Subcommittee on Management of Sinusitis; Committee on Quality Improvement. Clinical practice guideline: management of sinusitis. 2001;108(3):798-808. DOI: https://doi.org/10.1542/peds.108.3.798

Shahid SK. Rhinosinusitis in children. ISRN Otolaryngol. 2012;2012:851831. DOI: https://doi.org/10.5402/2012/851831

Ferguson BJ, Johnson JT. Infectious causes of rhinosinusitis. In: Cummings CW, Haughey BH, Thomas JR, Harker LA, Flint PW, Haughey BB et al. Cummings otolaryngology: head & neck surgery. 2005: 1182-1196.

Friedman DP, Rao VM, Flanders AE. Lesions causing a mass in the medial canthus of the orbit: CT and MR features. AJR Am J Roentgenol. 1993;160(5):1095-9. DOI: https://doi.org/10.2214/ajr.160.5.8470584

Hoxworth JM, Glastonbury CM. Orbital and intracranial complications of acute sinusitis. Neuroimaging Clin N Am. 2010;20(4):511-26. DOI: https://doi.org/10.1016/j.nic.2010.07.004

Soler ZM, Mace J, Smith TL. Symptom-based presentation of chronic rhinosinusitis and symptom-specific outcomes after endoscopic sinus surgery. Am J Rhinol. 2008;22(3):297-301. DOI: https://doi.org/10.2500/ajr.2008.22.3172

Wan Y, Shi G, Wang H. Treatment of Orbital Complications Following Acute Rhinosinusitis in Children. Balkan Med J. 2016;33(4):401-6. DOI: https://doi.org/10.5152/balkanmedj.2016.141065

Radovani P, Vasili D, Xhelili M, Dervishi J. Orbital complications of sinusitis. Balkan Med J. 2013;30(2):151-4. DOI: https://doi.org/10.5152/balkanmedj.2013.8005

Suhaili DN, Goh BS, Gendeh BS. A ten year retrospective review of orbital complications secondary to acute sinusitis in children. Med J Malaysia. 2010;65(1):49-52.

Bhalla V, Khan N, Isles M. Pott's puffy tumour: the usefulness of MRI in complicated sinusitis. J Surg Case Rep. 2016;2016(3):rjw038. DOI: https://doi.org/10.1093/jscr/rjw038

Jung J, Lee HC, Park IH, Lee HM. Endoscopic Endonasal Treatment of a Pott's Puffy Tumor. Clin Exp Otorhinolaryngol. 2012;5(2):112-5. DOI: https://doi.org/10.3342/ceo.2012.5.2.112

Tatsumi S, Ri M, Higashi N, Wakayama N, Matsune S, Tosa M. Pott's Puffy Tumor in an Adult: A Case Report and Review of Literature. J Nippon Med Sch. 2016;83(5):211-4. DOI: https://doi.org/10.1272/jnms.83.211

Goldberg AN, Oroszlan G, Anderson TD. Complications of frontal sinusitis and their management. Otolaryngol Clin North Am. 2001;34(1):211-25. DOI: https://doi.org/10.1016/S0030-6665(05)70307-8

Szyfter W, Bartochowska A, Borucki Ł, Maciejewski A, Kruk-Zagajewska A. Simultaneous treatment of intracranial complications of paranasal sinusitis. Eur Arch Otorhinolaryngol. 2018;275(5):1165-73. DOI: https://doi.org/10.1007/s00405-018-4932-5

DelGaudio JM, Evans SH, Sobol SE, Parikh SL. Intracranial complications of sinusitis: what is the role of endoscopic sinus surgery in the acute setting. Am J Otolaryngol. 2010;31(1):25-8. DOI: https://doi.org/10.1016/j.amjoto.2008.09.009

Tunkel AR, Hasbun R, Bhimraj A, Byers K, Kaplan SL, Scheld WM et al. 2017 Infectious Diseases Society of America's Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis. Clin Infect Dis. 2017;64(6):e34-65. DOI: https://doi.org/10.1093/cid/ciw861

Kasapoglu F, Coskun H, Ozmen OA, Akalin H, Ener B. Acute invasive fungal rhinosinusitis: evaluation of 26 patients treated with endonasal or open surgical procedures. Otolaryngol Head Neck Surg. 2010;143(5):614-20. DOI: https://doi.org/10.1016/j.otohns.2010.08.017

Arndt S, Aschendorff A, Echternach M, Daemmrich TD, Maier W. Rhino-orbital-cerebral mucormycosis and aspergillosis: differential diagnosis and treatment. Eur Arch Otorhinolaryngol. 2009;266(1):71-6. DOI: https://doi.org/10.1007/s00405-008-0692-y

Raza M. Extended application of functional endoscopic sinus surgery in ophthalmology and neurosurgery. PAFMJ. 2018;68(4):876-82.

Setliff RC, Parsons D. The “Hummer”: New Instrumentation for Functional Endoscopic Sinus Surgery. Am J Rhinol. 1994;8(6):275-80. DOI: https://doi.org/10.2500/105065894781874232

Kaliner MA, Osguthorpe JD, Fireman P, Anon J, Georgitis J, Davis ML et al. Sinusitis: bench to bedside. Current findings, future directions. Otolaryngol Head Neck Surg. 1997;116(6):S1-20. DOI: https://doi.org/10.1016/S0091-6749(97)70041-1

Daele JJ. Chronic sinusitis in children. Acta Otorhinolaryngol Belg. 1997;51(4):285-304.

Hebert RL, Bent JP. Meta-analysis of outcomes of pediatric functional endoscopic sinus surgery. Laryngoscope. 1998;108(6):796-9. DOI: https://doi.org/10.1097/00005537-199806000-00004