The Groote Schuur hospital classification of the orbital complications of sinusitis

Abstract

The complications of sinusitis have been well described. The most common classifications used for orbital complications have been that of Chandler et al. (1970) and Moloney et al. (1987). With the ready availability of high-resolution computed tomography (CT) scanners, limitations of these classifications have become apparent. The aims of this study were to determine the relative frequency of the various complications associated with acute sinusitis, to determine which groups of sinuses were most frequently involved and to correlate the orbital signs with a new proposed classification of orbital complications. Over a five-year period, 87 consecutive patients were admitted with acute sinusitis. Sixty-three patients (72.4 per cent) had one or more complications. When orbital complications were classified under the proposed classification, all patients with proptosis and/or decreased eye movement had post-septal infection. Visual impairment occurred only in the post-septal group. Most complications had a combination of sinus involvement with the maxillary/ethmoid/frontal combination being the most common. The authors propose a modification of Moloney's classification for orbital complications of acute sinusitis that allows a clear differentiation between pre- and post-septal infection and a radiological differentiation to be made between cellulitis/phlegmon and abscess formation. The latter is of importance when a decision is made on whether surgical intervention is appropriate or not.

Orbital cellulitis complicating sinusitis: a 15-year review

“…All the patients survived, but 11% became blind due to panophthalmitis and 16% had to have destructive surgeries. This is at variance with the study of Mortimore et al who had a 26% incidence of blindness 9 . The diagnosis of alveolar rhabdomyosarcomas on histology of specimen obtained during antrostomy highlights the importance of subjecting every specimen no matter how 'insignificant' to histology.…”

“…The most common pattern of sinus involvement causing orbital cellulitis was the combination of maxillary, ethmoidal and frontal sinuses (multisinusitis) which is similar to the result of Mortimore et al 9 However, the ethmoidal and maxillary sinuses were most frequently involved in the study by Swift et al 13 The multiple sinus involvement is probably an indication of the severity of the infection and the continuous nature of the mucosal lining of the paranasal sinuses.…”

“…3,4,7 The male preponderance also conforms to the findings of other workers. 3,4,8,9 Reasons for this is unclear. However, Kenny et al and Child have suggested that females were possibly more immunologically competent.…”

Microbiology of acute complicated bacterial sinusitis at the University of the Witwatersrand

“…This is in keeping with the universal acceptance of this organism as a major pathogen. [3][4][5][6][7][8]11,14,15 H. influenzae (8.6%) and coagulase-negative staphylococci (8.6%) ranked joint third. H. influenzae occurred more frequently in children than in adults (Table II).…”

“…2,9 This study identified only one isolate of M. catarrhalis (0.4%), which supports the consensus that this organism is not a major pathogen in complicated sinusitis. 1,[3][4][5][6][11][12][13][14] Anaerobic bacteria may account for as much as one-third of all isolates. 5,6 In this study they accounted for 13.3% (Table I).…”