CC BY
0RHINOSINUSOGENIC ORBITAL COMPLICATIONS IN
YOUNG CHILDREN
1Abdullayev X.N., 2Ismatova K.A.
1,2Tashkent Pediatric Medical Institute https://doi.org/10.5281/zenodo.13123245
Abstract. Rhinosinusogenic orbital complications in young children are serious conditions resulting from the spread of infection from the nasal sinuses to the orbit. These complications can lead to various visual and systemic disorders and require immediate medical attention. Young children are especially vulnerable to such complications due to their anatomical andphysiological characteristics.
Keywords: rhinosinusogenic orbital complication, acute respiratory viral infection, children.
Relevance. Rhinosinus orbital complication (RSOQ in children is a condition in which an infection, usually occurring in the sinuses of the face, spreads to surrounding tissues, including the orbit (eye socket cavity). According to S. Torretta et al. RSOС is more common in children under 5 years of age [6,13]. This age group is characterized by rapid generalization of the inflammatory process, severe course, severe intoxication with the development of neurotoxicosis [1,2,7,12,11]. The spread of the inflammatory process is possible by contact (bone destruction), lymphogenous, hematogenous routes, through vessels (thrombosis in the veins with subsequent purulent melting of the thrombus) and through digestion [7,8].
Causes and risk factors:
1. Respiratory infections: Sinus infections (sinusitis) can spread to the orbit.
2. Anatomical features: in young children, the lacrimal canal and nasal sinuses are located close to each other, which contributes to the rapid spread of infection.
3. Immune disorders: Immunocompromised children are more susceptible to complications [1,4,5,10].
The following rhinogenic orbital complications are distinguished: 1) reactive edema of the tissue of the orbit and eyelids; 2) diffuse non-purulent inflammation of the tissue of the orbit and eyelids; 3) osteoperiostitis of the orbit; 4) eyelid abscess; 5) fistula of the eyelid and orbital wall; 6) subperiosteal abscess; 7) retrobulbar abscess; 8) phlegmon of the orbit; 9) thrombosis of the veins of the orbital tissue, cavernous sinus [14].
RSOC is a serious complication that requires careful medical attention. Symptoms of rhinosinusogenic orbital complications in children may include swelling of the eyelids, tenderness of the eye with movement, protrusion of the eyeball, decreased vision, redness and discharge from the eye, fever and general weakness [8,9].
Treatment of rhinosinusogenic orbital complications in children involves antibiotic therapy to control the infection, often combined with sinus drainage to remove pus. In some cases, surgery may be required to remove the abscess from the orbital area. However, the severity of the condition of this group of patients requires further study of this pathology in order to find the most effective treatment options.
Purpose: to study the causes and frequency of development of rhinosinusogenic orbital complications in young children, as well as to study the features of the microbial landscape in patients with rhinosinusogenic orbital complications.
Material and methods. An analysis of child patients who were hospitalized in children's ENT department of TashPMI clinic (2022-2023) with rhinogenic orbital complications was carried out. All patients were hospitalized for emergency reasons and all patients underwent examination of ENT organs using standard methods, laboratory examination, examination by an ophthalmologist, pediatrician, neurosurgeon, X-ray, CT or MRI. Among them there were 16 girls and 21 boys aged from 1 to 5 years.
The total number of sick children by age was divided into 2 groups: from 1 to 3 years - 22 patients, from 4 to 5 years - 15 patients. The predominance of males is observed in all age groups, which is also consistent with the literature data. Before hospitalization, all children suffered from influenza, ARVI, (ACUTE RESPIRATORY VIRAL INFECTION) and nasopharyngitis, which were the most common causes of acute purulent rhinosinusitis. The most common occurrence of RSOС was in patients with ethmoiditis 25/37 (67.6%).
Results. All children were admitted with complaints of nasal discharge (96.6%) and difficulty in nasal breathing (32/86.5%). In most cases, the discharge was purulent in nature (29/78.4% of patients). 14/37.8% of children were bothered by cough and fever up to 39.2°C. All children had a history of being sick for about 3 days. Initially, there were complaints of an increase in body temperature to 39.0°C; after a couple of days, swelling of the eyelids, hyperemia, and pain in the eyes when moving appeared.
The bulk of RSOС in our study was represented by reactive edema of the tissue of the eyelids and orbit (29/78.4%), osteoperiostitis of the orbit (3/8.1%) eyelid abscess (4/10.8%), subperiosteal abscess (1/2.7%) less often met according to the classification of B.V. Shevrygina (1976) (Fig. 1.).
■ Reactive swelling of the tissue of the orbit and eyelids29/78,4%
■ Orbital osteoperiostitis 3/8,1%
■ abscess of the eyelid 4/10,8% subperiosteal abscessl/2,7%
After laboratory studies, it became known that the leading pathogens of RSOС are: S. aureus (12/32.4%) - Staphylococcus aureus and
S. Epidermidis (8/21.6%), Haemophilus influenzae (7/18.9%) - S. Pneumoniae 10/27.02%.
The results of a bacteriological study of the mucous membranes of the nasal passages are presented in the table.
Table 2. Bacterological examination of the mucous membranes of the nasal passages
Microorganism n=37 %
S. aureus 12 32,4%
S. Epidermidis, 8 21,6%
Haemophilus influenzae 7 18,9%
S. pneumoniae 10 27,02%
For antibacterial treatment, we used drugs from the cephalosporin group.
During the study, all patients were divided into 2 groups; they were identical in age and nature of inflammation, the main difference between them being the choice of antibacterial drugs.
In the 1st group there are 18 children, of whom 10 are boys and 8 girls, in the 2nd group there are 19 children, of whom 11 are boys and 8 - girls. The age of children in both groups is from 1 to 5 years. For all children from both groups, the causative agent of the disease and its sensitivity to antibacterial drugs were determined.
In group 1, drugs were selected empirically, parenterally - cefazolin (The average duration of treatment is 8-10 days) 3 times a day. For the treatment of patients of the 2nd group, cefotaxime was used 2 times a day (according to the results of microbiological tests) intravenously, intramuscularly, protorgol 2% in the nose, daily drainage of the sinuses using the cuckoo method (rinsing the PNS according to Proetz).
Already after the first course, 16/88.8% of patients noted a significant improvement in their condition, a decrease in the frequency of registration of main complaints and the severity of objective clinical symptoms of the disease. It should be noted that positive dynamics in the main group occurred two to three days earlier. The average duration of treatment in the hospital for children of the 1st group was 9 days and 7 days - for the 2nd group.
The treatment results were assessed based on a set of signs: an increase in subjective indicators of the condition, normalization of control radiographs of the paranasal sinuses, MRI and CT scans, normalization of the rhinoscopic picture.
Conclusions.
1. Rhinosinusogenic complications, the most common orbital complications occurred in patients with ethmoiditis - 25 (67.6%), and this complication was more common in boys.
2. Cefotaxim is an effective treatment for orbital complications due to its broad spectrum of action and ability to penetrate well into the affected tissue. However, treatment should be carried out under the supervision of a physician who can correctly assess the severity of the condition and prescribe the appropriate dosage and duration of therapy.
3. In young children, a bacteriological study showed that the leading causative agents of rhinosinusogenic orbital complications are: S. aureus (32.4%) - Staphylococcus aureus. Thus, conducting courses of antimicrobial therapy with preliminary bacteriological analysis for the
sensitivity of microflora is an important step for effective and personalized treatment of
rhinosinusogenic orbital complications.
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