Different Managements of Periorbital Cellulitis

Introduction: Acute infection of the paranasal sinus is a rather frequent pathology, on the contrary the local and particularly orbital complications are rare. Endonasal and orbital features don’t permit a correct classification and don’t identify the presence of orbital abscess, consequently it is mandatory to perform a CT scan. The aim of this presentation is to describe our therapeutic management in 7 patients with periorbital cellulitis. Materials and Methods: Between 2000 and 2006, 7 patients, 6 younger than 9 and one 22 years old came to our department with marked edema of eyelids of sudden onset. In 4 patients the medical treatment permitted a complete resolution 2 patients presenting abscessual cavity underwent urgent surgical procedure. 1 patient received programmed surgical treatment after a second episod of rhinosinusitis complicated with proptosis. All patients received CT at the diagnosis of periorbital cellulitis. A wide spectrum antibiotic iv therapy associated with systemic and local corticotherapy was begun. When an abscess was found at CT scan surgical endoscopic endonasal procedure were performed. Only in the case of eyelids abscess an external incision was necessary. Results: Since first days the chemosis and proptosis appeared reduced. The endoscopy confirmed the endonasal improvement where not sign of infection was evident. Discussion: The cases reported underwent different treatments depends on their different clinical stages. We recurred to surgery when despite 24 h medical therapy the clinical signs weren’t reverted, when at CT an abscess was evident, and when the clinical features were recurrent after an initial regression.