Complicações orbitárias de rinosinusite aguda em idade pediátrica: 10 anos da nossa experiência - Oportunidade para um protocolo terapêutico

Abstract

Objectives: Acute rhinosinusitisis a very common diagnosis in the paediatric population. Despite its usual favourable course, it can sometimes complicate, namely to the orbital compartment, which represents a threat to vision, even with appropriate and aggressive treatment. Our primary goal was to analyse the reality of a portuguese hospital during the past 10 years, discussing there sults and comparing them with the literature. We also propose a therapeutic protocol in cases of paediatric rhinogenic orbital complications. Material and Methods: We conducted a retrospective descriptive study of all the cases of paediatric rhinogenic orbital complication cases treated at our tertiary care hospital between January 2007 and September 2017. We analysed the demographic data, symptoms at presentation, imaging findings, antibiotic choice, need for surgery and the length of hospital stay. We elaborated a therapeutic protocol for cases of orbital complications secondary to acute paediatric rhinosinusitis. Results: 73% of the 137 children admitted for orbital complications secondary to acute rhinosinusitis did not present any relevant prior history. The mean age at presentation was 7 years old, being peri-orbital oedema and orbital pain the two most frequent symptoms at presentation. The majority of the children was classified as Chandler I (36%) followed by Chandler III (31%). The most frequently prescribed antibiotic regimen was the association of amoxicillin with clavulanic acid. The majority of cases resolved without the need for surgical intervention (84%). Conclusions: The complications of acute rhinosinusitis are challenging due to the potential morbidity they can inflict. Timely diagnosis and aggressive medical treatment, combined in some selected cases with surgical treatment, achieve good outcomes. The existence of therapeutic protocols helps decision process, supporting the choices of the medical team.