Sinusitis-associated epidural abscess presenting as posterior scalp abscess--a case report

Imaging of Paranasal Sinus Infections in Children: A Review

Paranasal sinuses (PNS) infections are common in children. They may cause common and well-known complications, but also, unusual and potentially devastating complications. Diagnosing PNS infections and complications in children requires knowledge of the unique anatomy of the nasal cavity and the PNS. In fetal life, nasal mucosa evaginations into the lateral nasal walls initiate the development of the PNS. The PNS continue to develop after birth and complete their maturation and pneumatization at different ages during childhood which makes the pattern of PNS infections determined by patient age. Complications are caused by direct spread of the infection to the orbit, face, intracranial or osseous structures or hematogenous spread of the infection to the intracranial structures. Emergent imaging studies are often necessary in the evaluation of the complications in pediatric patients when the symptoms persist for 10 days and/or if there is evidence of intracranial or orbital complications. In addition, immunocompromised children are especially vulnerable to developing unusual complications. Computed tomography (CT) is excellent for determining whether there is intraorbital extension of PNS disease. However, when the infection approaches the orbital apex, a magnetic resonance imaging (MRI) study with contrast is necessary to assess spread into the cavernous sinus and the intracranial compartment. The goal of this manuscript is to review and characterize imaging findings of PNS infections using CT and MRI allowing determination of the extent of PNS infections and their common and unusual complications in children. In addition, a summary of the development of the normal PNS is provided.

Periorbital cellulitis, subgaleal abscess and superior sagittal sinus thrombosis: a rare combination of complications arising from unilateral frontal sinusitis

Background:

Subclinical infection of the sinuses can result in delayed diagnosis and unusual presenting complications.

Case report:

This paper describes the case of a 14-year-old boy with a rare combination of periorbital cellulitis, subgaleal abscess and superior sagittal sinus thrombosis following a late presentation of unilateral frontal sinusitis.

Results:

Following multiple surgical procedures, and antimicrobial and anticoagulation therapy, the patient made a full recovery.

Conclusion:

Serious sinusitis complications still occur, and can do so in unusual combinations with minimal clinical signs. Systemic anticoagulation therapy is considered safe practice in the management of cerebral venous sinus thrombosis and may reduce morbidity and mortality.

Frontal sinus anatomical variations with potential consequences for the orbit. Study on cadavers

Anatomical variations of the frontal sinuses that may play a role in the correlation between frontal sinusitis and orbital complications are described. There were used 18 cadavers during routine educational cadaver dissections, one month after theirs withdrawal from the formol basin. The dissections of the cranial cavity and the orbits were performed so as to reveal the frontal sinuses. An unusual bilateral posterior extension of the frontal sinus mucosa was found in two of the cadavers. The projection of the mucosa was covering half of the orbital roof in a 60 year old male and one third of the orbital roof in a 59 year old male. Among the other cadavers that presented normal variations of the frontal sinuses, there was also a case of a 57 year old female with a complete aplasia of the frontal sinuses. Such anatomical variations with unusual extension of the frontal sinuses above orbital roof may support the correlation between frontal sinusitis and the possible complications from the orbit and these cases may be considered as 'high risk' cases for orbital complications during a frontal sinusitis.

Chronic postoperative epidural abscess with ascending neuromyotonia

IMPLICATIONS

Clinicians are reminded that epidural abscesses may not follow epidural space violation, may present a confusing constellation of back pain and paraparesis, and may have serious consequences if not diagnosed accurately and managed aggressively with spinal decompression.

Pott's puffy tumor and epidural abscess arising from dental sepsis: a case report

OBJECTIVE

To present an unusual case of two uncommon cranial complications of frontal sinusitis: Pott's puffy tumor and epidural abscess arising from frontal sinusitis of dental origin, and also two systemic complications of sinusitis: septicemia and empyema, all occurring in an immunocompetent patient.

STUDY DESIGN

A 21-year-old man presented with a scalp swelling and epidural abscess. Magnetic resonance imaging and computed tomographic scans revealed unilateral opacification of the frontal sinus and an epidural abscess with a direct connection to the scalp abscess. Further history revealed that his symptoms occurred coincidentally with a tooth extraction 2 months before, and he was hospitalized soon after the tooth extraction for sepsis and a lung abscess.

METHODS

A combined neurosurgical and otolaryngologic approach was required to treat the sinusitis and the associated epidural and scalp abscess.

RESULTS

Cultures returned as Streptococcus intermedius from all three sites. The patient was free of disease at the 3-month follow-up.

CONCLUSIONS

Odontogenic maxillary sinusitis is well documented; however, there is little reported of frontal sinusitis arising from dental disease. The prevalence of sinusitis of dental origin will be reviewed, including the microbiology of this particularly virulent organism that persisted despite earlier treatment with ampicillin. Also, the current thoughts on management of these cases will be discussed with particular reference to local therapy for sinusitis in addition to systemic treatment with antibiotics.