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Frontal Sinus Drainage in Acute Pediatric Sinusitis With Intracranial Complications
Stephen R Chorney1,2, Adva Buzi3,4, Mark D Rizzi3,4
1Department of Otolaryngology-Head & Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
Insights
Addressing the frontal sinus in pediatric acute sinusitis with intracranial abscesses did not reduce subsequent surgeries or complications. The study found no clear benefit on clinical outcomes when comparing different frontal sinus drainage methods.
Area of Science:
- Pediatric Otolaryngology
- Neurosurgery
- Infectious Diseases
Background:
- Managing pediatric acute sinusitis with intracranial complications presents challenges, particularly regarding frontal sinus involvement.
- The necessity of frontal sinus drainage in these complex cases remains unclear.
Purpose of the Study:
- To evaluate if surgical intervention of the frontal sinus impacts the need for subsequent procedures in children with acute sinusitis and intracranial abscess.
- To compare outcomes based on the method of frontal sinus management: endoscopic drainage, intracranial opening, or no drainage.
Main Methods:
- A retrospective case series involving children under 18 who underwent surgery for acute sinusitis with intracranial abscess and frontal sinus involvement.
- Outcomes were analyzed for patients who had their frontal sinus drained endoscopically, opened via a cranial approach, or left undrained.
Main Results:
- Thirty-five children were included; 37% presented with epidural abscess. Repeat surgeries were needed in 46% of cases, with 31% readmitted within 60 days.
- No significant differences were observed in demographics, infection severity, repeat surgery rates, length of stay, or readmissions among the different frontal sinus management groups.
- The persistence of neurological sequelae, including cranial neuropathies and seizures, was similar across all groups.
Conclusions:
- Frontal sinus drainage, when feasible, did not demonstrate a reduction in the number of surgical procedures or an increase in complications.
- The clinical benefit of actively draining the frontal sinus in this patient population is uncertain based on the measured outcomes.
Background:
The indication for frontal sinus drainage is uncertain when managing pediatric acute sinusitis with intracranial complications.
Objective:
The primary objective was to determine if addressing the frontal sinus reduced need for subsequent surgical procedures in children presenting with acute sinusitis complicated by intracranial abscess.
Methods:
A case series with chart review was performed at a tertiary children's hospital between 2007 and 2019. Children under 18 years of age requiring surgery for complicated acute sinusitis that included the frontal sinus with noncontiguous intracranial abscess were included. Outcomes were compared among children for whom the frontal sinus was drained endoscopically, opened intracranially, or left undrained.
Results:
Thirty-five children with a mean age of 11.1 years (95% CI: 9.9-12.3) met inclusion. Most presented with epidural abscess (37%). Hospitalizations lasted 12.9 days (95% CI: 10.2-15.5), 46% required a second surgery, 11% required three or more surgeries, and 31% were readmitted within 60 days. Initial surgery for 29% included endoscopic frontal sinusotomy, 34% had a frontal sinus cranialization and 37% did not have any initial drainage of the frontal sinus. Groups were similar with respect to demographics, severity of infection, need for repeat surgery, length of stay, and readmissions (p > .05). Further, persistence of cranial neuropathies, seizures, or major neurological sequelae after discharge were no different among groups (p > .05).
Conclusion:
Drainage of the frontal sinus, when technically feasible, was not associated with reduced surgical procedures or increased complications and there is unclear benefit on measured clinical outcomes.
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