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Saadouli D, Yahyaoui S, Ben Mansour K, Masmoudi M, El Afrit MA, Sammoud A. [Orbital cellulitis in children: Report of 60 cases]. J Fr Ophtalmol 2019; 42:1056-1061. [PMID: 31722808 DOI: 10.1016/j.jfo.2019.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 06/11/2019] [Indexed: 11/29/2022]
Abstract
The goal of this study was to describe the epidemiological, etiological, clinical and therapeutic features and clinical course of orbital cellulitis in children, and to assess the risk factors for retroseptal involvement. METHODS This was a retrospective study including 60 children (67 eyes) diagnosed with orbital cellulitis. Two groups were defined according to the clinical form: pre- or retroseptal. RESULTS We studied 29 cases (34 eyes) of preseptal cellulitis and 31 cases (33 eyes) of retroseptal cellulitis. The mean age was 4 years. The male: female ratio was 1.3. The prescription of anti-inflammatory drugs and antibiotics prior to hospitalization was noted in respectively four and 10 patients. Eyelid edema was the principal sign (100% of cases); exophthalmia was noted in 19 eyes, ptosis in 27 eyes and chemosis in 10 eyes. Oculomotor disorders were present in 4 eyes. The mean C-reactive protein level was 53.15±27mg/l in preseptal cellulitis and 92.09±21mg/l in the retro-septal cases. Orbital computed tomography was performed in 31 patients and MRI in 5 patients. The pathway of entry of the orbital infection was primarily from the sinuses (23 cases). All of our patients had received broad spectrum intravenous antibiotic therapy. Three children had a cavernous sinus thrombosis and had been treated with anticoagulant therapy. Surgical drainage was performed in five patients. The course was favorable and without sequelae for all the patients. Two independent risk factors for retroseptal involvement were identified: the prescription of anti-inflammatory drugs prior to hospitalization, and sinus involvement. CONCLUSION Orbital cellulitis in children is a serious infection and requires close collaboration between the ophthalmologist, otolaryngologist, and pediatrician in order to be diagnosed and treated early so as to improve the prognosis for vision and life.
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Affiliation(s)
- D Saadouli
- Service d'ophtalmologie au centre hospitalo-universitaire La Rabta, 1007 Jabbari Tunis.
| | - S Yahyaoui
- Service de médecine infantile de l'hopital d'enfant Bechir Hamza, 1006 Babb Saadoun Tunis
| | - K Ben Mansour
- Service d'ophtalmologie au centre hospitalo-universitaire La Rabta, 1007 Jabbari Tunis
| | - M Masmoudi
- Service d'ophtalmologie au centre hospitalo-universitaire La Rabta, 1007 Jabbari Tunis
| | - M A El Afrit
- Service d'ophtalmologie au centre hospitalo-universitaire La Rabta, 1007 Jabbari Tunis
| | - A Sammoud
- Service de médecine infantile de l'hopital d'enfant Bechir Hamza, 1006 Babb Saadoun Tunis
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Benoist G, Bidat E. [Persistent coughs in children and adolescents]. Arch Pediatr 2015; 22:447-51. [PMID: 25669121 DOI: 10.1016/j.arcped.2015.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 12/05/2014] [Accepted: 01/13/2015] [Indexed: 11/16/2022]
Abstract
A persistent cough lasting more than 4-8weeks should lead to a diagnostic workup. A detailed history and a full clinical examination, with a chest X-ray, are essential for initial assessment. Most reported causes of chronic cough in children are post-nasal drip syndrome, cough variant asthma (a spirometry with test of bronchodilator responsiveness should be attempted in children old enough to perform the manoeuvres). GERD is often suspected but a causal relationship is difficult to establish. Protracted bacterial bronchitis, post-infectious cough (B. pertussis, Mycoplasma) and somatoform respiratory disorders (including hyperventilation syndrome) are also common. Signs which are pointers suggesting an underlying respiratory or systemic disease require further investigation: inhaled foreign bodies, cystic fibrosis and chronic lung diseases with bronchiectasis, airway abnormalities, interstitial lung diseases need to be considered. Recent reports of refractory coughs have identified features of a sensory neuropathy disorder, and might explain persistent cough triggers.
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Affiliation(s)
- G Benoist
- Service de pédiatrie générale, CHU Ambroise-Paré, AP-HP, 9, avenue Charles-de-Gaulle, 92100 Boulogne, France; Université Versailles - Saint-Quentin-en-Yvelines, 78280 Guyancourt, France.
| | - E Bidat
- Service de pédiatrie générale, CHU Ambroise-Paré, AP-HP, 9, avenue Charles-de-Gaulle, 92100 Boulogne, France
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Chahed H, Bachraoui R, Kedous S, Ghorbel H, Houcine A, Mediouni A, Marrakchi J, Zainine R, Ben Amor M, Beltaief N, Besbes G. [Management of ocular and orbital complications in acute sinusitis]. J Fr Ophtalmol 2014; 37:702-6. [PMID: 25264151 DOI: 10.1016/j.jfo.2014.02.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 02/16/2014] [Accepted: 02/26/2014] [Indexed: 11/25/2022]
Abstract
PURPOSE Describe the clinical presentations of orbital complications of acute sinusitis and discuss therapeutic approaches. METHODS Retrospective study of 29 cases of acute sinusitis with orbital extension hospitalized over a period of 12years (2000 to 2012). RESULTS There were 23 men and 6 women. The mean age was 15.75years. The average time until consultation was 7.68 days. Sinusitis was ethmoido-maxillary in 20 cases, ethmoidal in 6 cases, and frontal in 3 cases. Orbital extension was grouped according to the Chandler classification: stage I (3 cases), stage II (3 cases), stage III (15 cases), stage IV (8 cases). Antibiotic therapy was prescribed in all cases. Surgery was performed in 22 cases. Bacterial cultures revealed streptococcus (2 cases), aspergillus fumigatus (1 case) and were negative in 8 cases. The outcome was favorable in 27 cases. In two cases, the outcome was unfavorable with associated intracranial complications. DISCUSSION Oculoorbital extension of acute sinusitis is a diagnostic and therapeutic emergency. Paranasal sinus CT is essential to confirm orbital extension and identify the causative sinus. Intravenous antibiotic therapy is the main treatment. The roles of corticosteroid and heparin therapy remain controversial. Surgery is indicated in the case of abscess or high visual risk. Endoscopic endonasal surgery appears to have a double role, in diagnosis and treatment.
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Affiliation(s)
- H Chahed
- Service ORL et chirurgie maxillofaciale, hôpital de la Rabta, La Rabta Jebbari, 1007 Tunis, Tunisie.
| | - R Bachraoui
- Service ORL et chirurgie maxillofaciale, hôpital de la Rabta, La Rabta Jebbari, 1007 Tunis, Tunisie
| | - S Kedous
- Service ORL et chirurgie maxillofaciale, hôpital de la Rabta, La Rabta Jebbari, 1007 Tunis, Tunisie
| | - H Ghorbel
- Service ORL et chirurgie maxillofaciale, hôpital de la Rabta, La Rabta Jebbari, 1007 Tunis, Tunisie
| | - A Houcine
- Service ORL et chirurgie maxillofaciale, hôpital de la Rabta, La Rabta Jebbari, 1007 Tunis, Tunisie
| | - A Mediouni
- Service ORL et chirurgie maxillofaciale, hôpital de la Rabta, La Rabta Jebbari, 1007 Tunis, Tunisie
| | - J Marrakchi
- Service ORL et chirurgie maxillofaciale, hôpital de la Rabta, La Rabta Jebbari, 1007 Tunis, Tunisie
| | - R Zainine
- Service ORL et chirurgie maxillofaciale, hôpital de la Rabta, La Rabta Jebbari, 1007 Tunis, Tunisie
| | - M Ben Amor
- Service ORL et chirurgie maxillofaciale, hôpital de la Rabta, La Rabta Jebbari, 1007 Tunis, Tunisie
| | - N Beltaief
- Service ORL et chirurgie maxillofaciale, hôpital de la Rabta, La Rabta Jebbari, 1007 Tunis, Tunisie
| | - G Besbes
- Service ORL et chirurgie maxillofaciale, hôpital de la Rabta, La Rabta Jebbari, 1007 Tunis, Tunisie
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[Endoscopic treatment of orbital cellulitis in pediatric patients: transethmoidal approach]. ACTA ACUST UNITED AC 2012; 88:271-5. [PMID: 23768475 DOI: 10.1016/j.oftal.2012.10.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2012] [Revised: 09/16/2012] [Accepted: 10/27/2012] [Indexed: 11/21/2022]
Abstract
Orbital cellulitis is a septic process of the soft tissues behind the orbital septum and is the most frequent cause of the monolateral exophthalmos in pediatrics. Approximately 90% of the orbital cellulitis in pediatrics are associated to acute ethmoiditis. From the 01.01.2001 to 31.12.2010 we treated 36 patients, less than 18 years-old affected by Chandler stage II, III, or IV orbital cellulitis. The inflammation was resolved medically in 6 patients. In the 30 cases that showed no improvement in 48-72 h, an endoscopic drainage of the pus was performed by the transethmoidal route. In children, an adenoidectomy should be included, in order to eliminate eventual infections of this lymphatic organ. Endoscopic treatment has resulted in rapid resolution of disease without any complications. In addition, postoperative discomfort is minimal, with a rapid return to daily activities.
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Amat F. [Complications of bacterial rhino-sinusitis in children: a case report and a review of the literature]. Arch Pediatr 2010; 17:258-62. [PMID: 20133116 DOI: 10.1016/j.arcped.2009.11.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2009] [Revised: 08/06/2009] [Accepted: 11/06/2009] [Indexed: 01/05/2023]
Abstract
Acute sinusitis in children is a controversial issue in terms of its diagnostic criteria, classification and therapeutic management. A therapeutic delay can lead to complications if the cause is bacterial. Guidelines have been set, but they are not consensual in pediatrics. Complications of acute bacterial sinusitis are uncommon in children, but they can be extremely severe and cause high morbidity and mortality. Because of their rarity, they often are not identified early, exposing the patient to an unfavorable outcome. We report on a case of acute bacterial pan-sinusitis complicated with thrombophlebitis of the cavernous sinuses and meningitis in a 9-year-old child, in spite of early and adapted antibiotic therapy. The bacterial agent was Staphylococcus aureus, which had no resistance or toxin profile. The progression was favorable under intravenous antibiotic therapy and after bilateral sphenoidectomy. This case raises the question of the best therapy for acute bacterial sinusitis in pediatrics and the management of complications.
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Affiliation(s)
- F Amat
- Service des urgences pédiatriques, hôpital d'enfants Armand-Trousseau, 75012 Paris, France.
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Current World Literature. Curr Opin Otolaryngol Head Neck Surg 2008; 16:292-5. [DOI: 10.1097/moo.0b013e3283041256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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