Clinical Markers of Need for Surgery in Orbital Complication of Acute Rhinosinusitis in Children: Overview and Systematic Review

Abstract

Background: Although they can occur at all ages, orbital (OC) and periorbital cellulitis (POC) prevail in the pediatric population. Acute rhinosinusitis (ARS) is the most frequent predisposing factor of OC. Recent literature has suggested a medical management approach for OC and POC, with surgery reserved only for more severe cases. However, there is still a lack of consensus on the clinical markers of a need for surgery. The aim of this systematic review was to identify clinical markers of a need for surgery in children with OC. Our systematic review, in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) process, yielded 1289 articles finally screened. This resulted in 31 full texts that were included in a qualitative analysis. The results of this review suggest that in children aged over 9 years, large subperiosteal orbital abscesses (SPOAs), impaired vision, ophthalmoplegia, proptosis, elevated C-reactive protein (CRP) and absolute neutrophil counts (ANC), hemodynamic compromise, no clinical improvement after 48/72 h of antibiotic therapy, and a Chandler III score or higher are clinical markers of the need for surgery. However, most of the studies are observational and retrospective, and further studies are needed to identify reliable and repeatable clinical markers of the need for surgery.

Celulite Orbital E Empiema Subdural Como Complicações De Pansinusopatia Aguda Em Paciente Pediátrico: Relato De Caso

“…al., 2013;SOUZA et. al., 2011;CANTONE et. al., 2022) É conhecido que as complicações orbitárias são as mais comuns na sinusite aguda, entre 74 a 85% das complicações, com incidência de 3-4% na população pediátrica com quadro de rinossinusite aguda.…”

“…al., 2022) Inicialmente, pela clínica, a criança apresentava um quadro sugestivo de celulite orbitária, uma vez que havia diminuição da motricidade ocular e da acuidade visual, característica da celulite orbital (Chandler II), porém os sintomas neurológicos como a perda de sensibilidade motora e sonolência, levou a equipe a pensar na hipótese de complicação intracraniana, sendo (WONG et. al., 2018;CANTONE et. al., 2022;SALTAGI et.…”

“…al., 2021) Porém, algumas literaturas apontam uma incidência entre 3,7 a 11% em pacientes hospitalizados (SZYTER et. al., 2018), outras apontam incidência menor, de 0,7% das crianças que procuraram o serviço de emergência, ( CANTONE et. al., 2022) que variam de acordo com a região geográfica, clima e condições socioeconômicas (ZIEGLER at.al., 2018;(SZYTER et.…”