Otorhinolaryngology · MU Plovdiv

9. Pediatric Rhinosinuitis. Orbital complications in diseases of the nose and paranasal sinuses. Cerebrospinal Fluid Rhinorrhea

Inside: 15 sections · 10 labelled pictures · 1 table · 15 flashcards · 9 min

Topic 9 of 18 in the MU Plovdiv syllabus for Otorhinolaryngology (Medicine, Year 4). The free AceMed note covers it in 15 sections, about 1,202 words (9 min of reading), with 15 flashcards.

In this note

  1. Pediatric Rhinosinusitis. Orbital complications in diseases of the nose and paranasal sinuses. Cerebrospinal Fluid Rhinorrhea
  2. Pediatric Rhinosinusitis
  3. Orbital Complications:
  4. I. Inflammatory Edema (Preseptal Cellulitis)
  5. II. Orbital cellulitis(Postseptal Cellulitis)
  6. III. Subperiosteal Abscess (SPA)
  7. IV. Orbital abscess
  8. V. Cavernous sinus thrombosis (CST)
  9. Bone Complications:
  10. Cerebrospinal Fluid Rhinorrhea
  11. Etiology (6)
  12. Symptoms:
  13. Diagnosis
  14. Treatment
  15. Complications

Pediatric Rhinosinusitis

  • Inflammation of the nose & paranasal sinuses in children
  • Most commonly affected are the maxillary sinuses
  • Characterized the presence of 2 or more symptoms
  • 1 of the 2 must be either Nasal Obstruction & Rhinorrhoea
  • Others: Facial pain/pressure, Hypo/Anosmia (partial/total loss of smell)
  • Associated w/ Endoscopic signs and/or CT Abnormal changes

Acute

  • < 4 weeks
  • total resolution of symptoms

Subacute

  • > 4 weeks but < 12 weeks
  • Total resolution of symptoms

Recurrent acute

  • 4 + episodes / year
  • Total resolution of symptoms between attacks

Chronic

  • > 12 weeks or more

Endoscopic changes:

  1. Polyps and/or
  2. Purulent secretion from MNM and/or
  3. Edema / Mucosal obstruction in MNM

CT changes:

  1. Mucosal changes at the level of Osteomeatal or of the paranasal sinuses

Orbital Complications:

  • Most commonly arises Ethmoid or Frontal Sinuses < 6yo
  • Less commonly Sphenoid or Maxillary Sinuses

Types: Clinical Grades

  1. Extracranial
  • Orbital infections: Orbital cellulitis / Subperiosteal Abscess
  • Hyperostosis & Osteitis
  • Mucocele
  • Osteomyelitis- Pott’s Puffy Tumor
  • Middle ear cleft infection
  1. Intracranial (direct extension/ Retrograde TP )
  • Meningitis (sphenoid/ ethmoid)
  • Epidural / Subdural abscess (Frontal)
  • Brain Abscess (Frontal)
  • Cavernous Sinus Thrombosis
  1. Pulmonary Infections
  2. Sepsis

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