Background: Orbital abscess is an uncommon complication of rhinosinusitis especially involving the ethmoidal sinuses. It is commonly seen in children and drainage could be external, endoscopic or combined. Orbital abscesses complicating frontal sinusitis are uncommon.
Objective: Discuss the best route of drainage of superolateral orbital abscess complicating frontal sinusitis. Setting: Tertiary care urban referral hospital in a developing country.
Methods: 3 cases of orbital abscesses complicating frontal sinusitis, seen in an older pediatric male and two middle aged females are presented, and available literature reviewed. The peculiar challenges that their management posed especially regarding limitation of endoscopic approach are discussed.
Results: All cases had attempted endoscopic drainage and drainage via Lynch incisions that were abortive. Final route of successful drainage in the three cases was a superolateral brow incision. In all cases, drainage via superolateral brow incision combined with frontal sinus irrigation through trephining was successful.
Conclusion: Otolaryngologists need to be aware that superolateral orbital abscesses are best drained by external routes as endoscopic access to these abscesses is very limited.

Superolateral Orbital AbscessComplicating Frontal Sinusitis -Need to Emphasize the ExternalApproach

Objective
To investigate the clinical features, diagnosis and surgical intervention for orbital complications of acute rhinosinusitis in adults. 


Methods
Four adults patients with orbital complications of acute rhinosinusitis were restrospectively reviewed. After conservative managements failed, these patients were treated by transnasal endoscopic sinus surgery or combined with eyebrow incision. 


Results
There were 2 cases with orbital abscess, 2 cases with subperiosteal abscess. Among them, 2 patients suffered from diabetes. After operation, constitutional symptoms and ocular symptoms disappeared in all 4 patients. CT was rechecked during the postoperative follow-up. The imaging showed that the orbital and nasal lesions were obviously relieved or disappeared. 


Conclusions
The orbital complications of acute rhinosinusitis in adults are clinically rare. The patients are usually with lowered immunity or with underlying conditions, such as diabetes. On the basis of controlling basic diseases, the treatment outcome of orbital complications of acute rhinosinusitis in adults is affirmative by surgery and conservative managements.


Key words: 
Sinusitis ;  Orbital diseases ;  Adult;  Acute disease

Clinical analysis of orbital complications of acute rhinosinusitis in adults

To report our experience using endoscopic intranasal incision reduction (EIIR) for nasal fractures and to assess effectiveness of the method. 30 patients who underwent EIIR were retrospectively analysed. All the patients were examined by three-dimensional computed tomography (3D CT), acoustic rhinometry and rhinomanometry, preoperatively and postoperatively at 1 month. The visual analogue scale (VAS) was used to assess the preoperative aesthetics and nasal airflow satisfaction and at 1, 3 and 6 months postoperatively. VAS aesthetic satisfaction was also scored by two junior doctors. 3D CT showed that the fracture fragments fitted well in 30 patients postoperatively at 1 month. VAS aesthetics and nasal airflow scores were significantly improved postoperatively at 1, 3 and 6 months compared with preoperative scores (P < 0.01). The VAS aesthetic scores from the two surgeons were also significantly improved (P < 0.01). The minimal cross-sectional area increased from 0.39 ± 0.13 to 0.64 ± 0.13 (P < 0.001), the nasal volume increased from 4.65 ± 0.86 to 6.37 ± 0.94 (P < 0.001) and the total inspiratory airway resistance of the bilateral nasal cavity median decreased from 0.467 Pa/mL/s to 0.193 Pa/mL/s (P < 0.001). There were no technique-related intraoperative complications. EIIR was a practical choice, and the aesthetics and nasal airflow were significantly improved in patients with overlapped and displaced bone fragments, patients with fractures of the frontal process of the maxilla (FFPM), patients who underwent failed CR and patients beyond the optimal temporal window.

/pdf/effectiveness-of-endoscopic-intranasal-incision-reduction-4pqkfr24uc.pdf

Effectiveness of endoscopic intranasal incision reduction for nasal fractures

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Clinical analysis of orbital complications of acute rhinosinusitis in adults

Effectiveness of endoscopic intranasal incision reduction for nasal fractures