Interesting descriptive study of a decade’s worth of children transferred/admitted to Texas Children’s in Houston with intra-orbital or intra-cranial extension of their sinusitis. It’s really just a summary of the clinical and hospital courses of 118 patients identified through retrospective chart review.
Interesting tidbits:
– Of these patients, 40% had been prescribed outpatient courses of antibiotics prior to the time of diagnosis of intra-cranial or intra-orbital extension.
– All patients with intra-orbital involvement presented with eye swelling.
– Intra-cranial extension had substantially (and significantly) more headache and vomiting, and only 67% received antibiotics prior to transfer.
– Identical numbers in each group – 16% – of patients were afebrile upon presentation.
– 33% of patients with intracranial extension of sinusitis did not complain of a URI-like syndrome at presentation.
– Frontal sinus involvement was associated with 84% of their intra-cranial extension.
– All organisms recovered were sensitive to clindamycin or vancomycin plus cefotaxime except for a single pseudomonal infection.
– There were no deaths, and four patients had persistent neurologic or visual sequelae.
Short summary – orbital cellulitis was a little more straightforward in diagnosis than intracranial extension of sinusitis, and a significant minority of both groups would definitely diagnostic challenges. CT imaging, anathema as it may be, is the diagnostic modality of choice.