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[Frontal sinusitis, mucocele and subperiosteal superolateral orbit abscess]
N Pham Dang1, A Bouchet, J-M Mondie
1Service de Stomatologie, Chirurgie Maxillo-Faciale, Chirurgie Plastique de la Face, Hôtel-Dieu, CHU de Clermont-Ferrand, Boulevard Léon-Malfreyt, 63058 Clermont-Ferrand Cedex, France. nphamdang@chu-clermontferrand.fr
Insights
A rare periorbital abscess in a child, stemming from pansinusitis, highlights the need for prompt diagnosis and treatment. Early intervention is crucial to prevent severe orbital and intracranial complications.
Area of Science:
- Otolaryngology
- Pediatric Ophthalmology
Background:
- Periorbital infections are rare but serious complications of pansinusitis.
- Chandler's classification (1970) aids in managing these infections based on severity.
Observation:
- An 8-year-old presented with pansinusitis unresponsive to treatment.
- Symptoms progressed to palpebral edema and proptosis, indicating a subperiosteal abscess.
Findings:
- CT and MRI confirmed a superolateral subperiosteal abscess.
- A coexisting frontal mucocele was identified, suggesting sinus-orbital communication.
Implications:
- Early diagnosis and tailored treatment (medical/surgical) are vital for subperiosteal abscesses.
- Frontal sinusitis with a mucocele can lead to superinfection and periorbital abscess formation.
- This case underscores the importance of imaging in identifying complex sinus and orbital infections.
Introduction:
Periorbital infection following pansinusitis is a rare complication which can lead to irreversible orbital and intracranial consequences. Chandler classified them in 1970.
Observation:
An eight-year-old child presented with a subperiosteal superolateral abscess. The initial flu-like syndrome developed into pansinusitis resisting to usual treatment. Palpebral edema and major exophthalmia then appeared requiring CT scan and MRI, which confirmed a subperiosteal abscess.
Discussion:
A subperiosteal abscess is a serious condition requiring an early diagnosis and a medical or surgical treatment adapted to the severity. Chandler's classification gives the opportunity to adapt management to the infection's gravity. Ethmoiditis may be complicated by periorbital abscesses found usually in the superointernal quadrant. Medical imaging and surgical treatment confirmed a superolateral periorbital abscess and a frontal mucocele. This case illustrates the possibility of communication between frontal sinus and orbital cavity. During frontal sinus infection, pre-existing mucocele may become super-infected and induce a periorbital abscess.
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