Complications Of Sinusitis Research Articles

264. A 20-year Study of Intracranial Pyogenic Complications of Sinusitis in Children

Abstract Background Intracranial pyogenic complications of sinusitis in children are relatively uncommon but can lead to serious sequelae. The objective of this study was to characterize the clinical, epidemiologic and microbiologic characteristics of children with such complications over a 20-year period (2000- 2019). Methods Single-center retrospective chart review. Cases were identified based on International Classification of Diseases (ICD)-10 diagnostic codes (intracranial abscess or granuloma, extradural and subdural abscess, Pott’s puffy tumor, acute or chronic sinusitis) and by reviewing all microbiological samples of intracranial pus, tissue or fluid. Results 108 cases of clinically and/or radiologically diagnosed sinusitis were included after review of 1591 charts. The majority were adolescents (median age 12, IQR 9-14); 72 were male (67%). The most common presenting symptoms were fever (84%), headache (87%) and symptoms of upper respiratory tract infection (57%). Median symptom duration was 10 days (IQR 5-21) and 55 cases (51%) received oral antibiotics prior to admission. The most frequent complications were epidural empyema (n=50, 46%), subdural empyema (n=46, 43%) and Pott’s puffy tumor (n= 31, 29%). 50% (n=54) underwent neurosurgery, of which 20% (n=11) required multiple craniectomies. 38% (n=41) underwent otolaryngological surgery. Microbiological data from sterile specimens demonstrated single organisms in 36 cases (59%) and polymicrobial growth in 25 cases (41%). The most frequently identified pathogens were Streptococcus anginosus (n=40, 66%) followed by Fusobacterium species (n=10, 16%) and Prevotella species (n=10,16%). Most cases were treated with combination antibiotic therapy (n=68, 63%) and 14% (n=15) with a carbapenem. The median duration of intravenous antibiotic therapy was 51 days (IQR 42-80). One child died and 23% (n=25) suffered neurological sequelae (median follow-up 344 days). 48 cases (44%) occurred between 2014-2019. Conclusion Intracranial complications of sinusitis continue to cause significant morbidity in children. The predominant causative pathogen was Streptococcus anginosus. Polymicrobial infections are common, confirming the need for prolonged broad-spectrum antibiotic treatment. Disclosures Sharon Cushing, MD, MSc, FRCSC, Cochlear Corporation (Research Grant or Support)Cochlear Corporation (Speaker’s Bureau)Interacoustics (Speaker’s Bureau)Plural publishing (Other Financial or Material Support, Royalties: editor: manual of pediatric balance disorders)

Topical Nasal Decongestant Oxymetazoline: Safety Considerations for Perioperative Pediatric Use.

The over-the-counter nasal decongestant oxymetazoline (eg, Afrin) is used in the pediatric population for a variety of conditions in the operating room setting. Given its vasoconstrictive properties, it can have cardiovascular adverse effects when systemically absorbed. There have been several reports of cardiac and respiratory complications related to use of oxymetazoline in the pediatric population. Current US Food and Drug Administration approval for oxymetazoline is for patients ≥6 years of age, but medical professionals may elect to use it short-term and off label for younger children in particular clinical scenarios in which the potential benefit may outweigh risks (eg, active bleeding, acute respiratory distress from nasal obstruction, acute complicated sinusitis, improved surgical visualization, nasal decongestion for scope examination, other conditions, etc). To date, there have not been adequate pediatric pharmacokinetic studies of oxymetazoline, so caution should be exercised with both the quantity of dosing and the technique of administration. In the urgent care setting, emergency department, or inpatient setting, to avoid excessive administration of the medication, medical professionals should use the spray bottle in an upright position with the child upright. In addition, in the operating room setting, both monitoring the quantity used and effective communication between the surgeon and anesthesia team are important. Further studies are needed to understand the systemic absorption and effects in children in both nonsurgical and surgical nasal use of oxymetazoline.

Rapidly Progressive Complicated Acute Bacterial Sinusitis in the Setting of Severe Pediatric SARS-CoV-2 Infection

This case report presents a case of a rapidly progressive complicated sinus infection in a child with the multisystem inflammatory syndrome in children. Case report with literature review. We present a novel case of severe rapidly progressive complicated sinusitis in a 14-year-old African American male diagnosed with the multisystem inflammatory syndrome in children. Infection was caused by an aggressive pathogen, Streptococcus intermedius (anginosus), and within 48 hours progressed to orbital, subgaleal, and intracranial abscess, requiring multidisciplinary intervention by ophthalmology, neurosurgery, and otolaryngology. Following surgical intervention and a 4-week course of intravenous antibiotic therapy, the patient had resolution of the infection with no neurologic sequelae. Despite the low incidence of multisystem inflammatory syndrome in children, physicians should be aware that immunologic changes and the cytokine storm induced by severe acute respiratory syndrome coronavirus 2 can potentially predispose patients to severe bacterial or opportunistic infections. As more cases of MIS-C develop, associated complications can become evident. Similar cases of SARS-CoV-2 and severe bacterial sinusitis have been published in the literature, but it remains unclear if there is an association between SARS-CoV-2 disease and an increased risk of complicated sinusitis in children.

A Rare Case of Pott's Puffy Tumor in an Elderly Man with a Background of Schizophrenia

Pott's puffy tumor (PPT) was first described by Sir Percival Pott in 1768. It is a life-threating complication of infectious sinusitis, which presents as a forehead swelling due to osteomyelitis of the frontal bone with an associated subperiosteal abscess (Hasan et al, 2019). It is not a true neoplasm; the name "tumor" refers to the swelling that occurs on the forehead as a result of the spread of infection. It is extremely rare in the post-antibiotic era and, when it does occur, tends to affect children and adolescents as the frontal sinus completes its development in preadolescents (Karaman et al, 2008). Very few cases of PPT have been documented in elderly individuals. The authors report the case of Pott's puffy tumor in a 71-year-old man with a background of chronic sinus disease, paranoid schizophrenia, and drug-induced Parkinsonism.An elderly man with a 12-day history of a worsening forehead abscess presented to the emergency department after being referred by his GP following 6 days of unsuccessful antibiotic therapy. On examination, a large, erythematous swelling was noted on his central forehead, measuring 15cm in diameter (Figure 1). The abscess was tender on palpation and fluctuant. There were no visual changes, exophthalmos, enophthalmos, or involvement of the periorbital area. The patient had a normal cranial nerve examination, except for slightly decreased sensation in the central forehead. His vital signs demonstrated tachycardia and, interestingly, he did not have a fever.The patient had a background of paranoid schizophrenia and was taking monthly injections of the typical antipsychotic flupentixol, as well as the anticholinergic procyclidine, for the drug-induced Parkinsonism. The patient lived in sheltered accommodation, smoked 10 cigarettes per day, and consumed cannabis. Recently, to note, the patient had a 2-month stay in a nearby mental health hospital.The patient was admitted, and the abscess was drained and irrigated with saline. Overnight, the abscess re-collected, and bloody nasal discharge was reported. This was re-drained the following morning, and examination after drainage suggested a possible involvement into the frontal sinus. The patient was listed for a CT scan, which demonstrated subcutaneous collection and acute frontal sinusitis complicated by erosion of the anterior wall of the frontal sinus in keeping with osteomyelitis (Figure 2). The CT scan also showed osteitis of the right frontal sinus and bilateral maxillary and sphenoid sinus walls consistent with chronic sinus disease. There was no evidence on CT of intracranial or orbital involvement.The patient was diagnosed with Pott's puffy tumor and referred to otolaryngology colleagues. The patient was commenced on IV piperacillin/tazobactam (tazocin) 4.5g tds and vancomycin 1g tds and listed for Functional Endoscopic Sinus Surgery (FESS).This case highlights the need for early recognition and prevention of benign infections that may subsequently become sinister or fatal. If not identified and managed swiftly, Pott's puffy tumor has a life-threatening sequela due to involvement into the frontal lobes of the brain. Hence, it is importance to have a high clinical suspicion for PPT in the face of medical and psychosocial risk factors. The authors emphasize the importance of a multidisciplinary team approach to managing patients with PPT, with valuable input from otolaryngology, neurosurgery, microbiology, and histopathology enhancing patient care.

Invasive rhino-orbito-cerebral aspergillosis presenting as multiple cranial neuropathies – A case report

Presenting as a complication of paranasal fungal sinusitis, due to continuous spread of an invasive agent to adjacent tissues, the rhino-orbito-cerebral syndrome is frequently associated with Aspergillus or Mucor infections.

Pott’s Puffy Tumor - Overview of case series

Pott’s puffy tumor (PPT) is rare and usually seen as a complication of frontal sinusitis that has been neglected or partially treated, resulting in subperiosteal abscess of the frontal bone with underlying osteomyelitis, which can lead to life-threatening intracranial complications, such as epidural/subdural empyema, cerebral abscess and meningitis. Given this, the purpose of the present study was to gather the most diverse cases reported together to highlight the main treatment methods. Methods: It is a narrative review, starting from the search in the database PubMed, Lilacs and Scielo from 2010 to 2020, which resulted in 34 scientific articles. The search focused on obtaining data on new approaches and treatments established for Pott’s puffy tumor. Results: 34 articles were included which described 58 patients with a swollen Pott tumor, occurring predominantly in male adolescents, with streptococci (26,1%) as the main etiologic agent. Approximately 84% of all patients were male subjects. The most prevalent intracranial complication was an epidural or extradural abscess (84,2%). Regarding PTT therapy, all patients received antibiotic therapy (ATB), and the main empirical antimicrobial scheme used was cephalosporin third generation, with vancomycin and metronidazole. In most cases, surgery was performed using several techniques, mainly an external surgical approach, external drainage (ED) of the subperiosteal abscess associated with endoscopic sinus surgery (ESS). In general, the prognosis is favorable, even if neurological symptoms are present at admission. Conclusion: Based on available literature, PPT is a profoundly serious complication, which can be easily avoided if treated with the ATB, ED and ESS triad immediately, and, if necessary, craniotomy.

Pott's puffy tumor: as a very rare and unpredicted complication of ipsilateral pan sinusitis - case presentation and review of articles

Pott's puffy tumor is considered as a rare clinical entity. It is developed as a rare complication of frontal sinusitis. In addition, the trauma to the frontal area is another suggested cause. The Pott's puffy tumor is presented as a forehead swelling due to sub-periosteal collection. Although, the Pott's puffy tumor is a rare condition but at the same time, it can be serious because it may lead to life threatening complications namely, extradural abscess, subdural abscess, meningitis, encephalitis, and brain abscess. Thus, the Pott's puffy tumor is classified as a very significant surgical emergency.

Children’s head and neck infections caused by Streptococcus intermedius in the Pediatric Otolaryngology Department of Warsaw Medical University

Introduction. Streptococci are commonly known pathogens of the normal bacterial flora of the mouth, pharynx, gastrointestinal tract and genitourinary system. The most common infections are beta-hemolyzing streptococci causing pharyngitis, streptococcal angina, otitis and paranasal sinusitis. But not all streptococcal infections are easy to treat. They are those that forming abscesses in the deep tissues of the body and caused life-treating complications. Aim. The aim of the study is to draw attention to the pathogen of the Streptococcus viridans group, i.e. Streptococcus intermedius, which, being a saprophyte of the upper respiratory tract, may cause life-threatening complications during an infection. Material and methods. The age, sex of children, underlying disease, complications, conservative and surgical treatment of children treated in the Pediatric Otolaryngology Department of the Medical University of Warsaw due Streptococcus intermedius infections were analyzed. Results. 6 children in age from 14 months to 15 years were treated in the ENT Department of Warsaw Medical University due to Streptococcus intermedius infections. There were 5 boys and 1 girl. All children were diagnosed with abscesses in deep tissue as a complication of acute sinusitis in 4 children, pharyngitis in 1 and post trauma nasal bone in 1 child. All children were immunocompetent. The treatment of choice was antibiotic therapy and drainage of abscesses. All children were successfully treated. Conclusions. The isolation of Streptococcus intermedius in cultures taken from infection’s site in the upper respiratory tract is associated with the risk of complications in the form of deep head and neck and central nervous system abscesses. Each patient with an infection of Streptococcus intermedius etiology requires CT or MRI imaging of the craniofacial and brain due to the possibility of deep abscesses. The treatment of choice is antibiotic therapy with ceftriaxone, clindamycin and together with surgical drainage of the abscess. The sensitivity of Streptococcus intermedius to popular antibiotics is the reason for effective treatment despite serious complications.

A Case of Pott's Puffy Tumor from Odontogenic Source

AbstractPott's puffy tumor (PPT) is a known complication of frontal sinusitis. Odontogenic maxillary sinusitis can seldomly spread to involve the frontal sinus but has not been implicated in the development of PPT. Herein, we describe a case of frontal sinusitis originating from an odontogenic source and culminating in PPT.

Outcome of Orbital Complications of Acute Rhinosinusitis in Children

Background: Acute bacterial rhinosinusitis occurs commonly as a sequel to a viral upper respiratory tract infection. Spread of infection outside the sinuses to the surrounding brain and orbit results in complicated sinusitis. Complications are more common in children than adults due to anatomical and immunological factors. Objective: To identify the correlation of orbital manifestations with computed tomography (CT) scan findings in diagnosing and classifying the disease, the efficacy of various treatment modalities and the outcome of these complications in children. Methods: A prospective study of 16 patients who presented with orbital swelling and features of acute rhinosinusitis was conducted in the Otorhinolaryngology Department at Al-Imamein Al-Kadhimein Medical City from April 2014 to October 2015. A full history, ear, nose and throat (ENT) examination including naso-endoscopic examination (if possible), ophthalmological assessment and CT scan of nose and paranasal sinuses were done. Patients were classified to have either pre-or postseptal infection depending on CT findings. All patients were admitted to the ENT ward, received intravenous broad-spectrum antibiotics and supportive measures and kept under close observation with monitoring of ophthalmological manifestations and vital signs. Some patients responded to medical treatment and others required surgical intervention. All patients after recovery were discharged home on oral antibiotics for 2 weeks and followed up monthly for a total duration of 3 months. Results: The majority of patients were males (62.5%). Mean ages of patients was 8.9±2.9 years with a range (4 to 15) year. Preseptal cellulitis was more common (62.5% vs. 37.5%). Impaired visual acuity, impaired extraocular movement and proptosis were significantly associated with postseptal infections as the P values were 0.01, 0.003 and 0.003 respectively. Preseptal cellulitis responded well to medical treatment. Postseptal abscesses required surgical drainage using an external, endoscopic or combined approach. 94% of patients had complete recovery without any sequel. Conclusion: Orbital manifestations are strongly correlated with CT findings. Medical treatment is very effective for preseptal infection. The choice of surgical approach for managing postseptal infection will depend upon, the site and extension of the abscess and the state of the nasal cavity. Early and accurate management can reduce morbidity and mortality. Keywords: Orbital complications of sinusitis, pediatric rhinosinusitis, ethmoiditis Citation: Al-Hassani JMK. outcome of orbital complications of acute rhinosinusitis in children. Iraqi JMS. 2021; 19(1): 90-98. doi: 10.22578/IJMS.19.1.12

Facial nerve palsy as an unusual presentation of orbital apex syndrome

Clinical cases of orbital apex syndrome are rare and most commonly manifested as a complication of fungal sinusitis, mainly in immunocompromised and poorly controlled diabetic patients. Rhino-orbital mucormycosis is a rare opportunistic, aggressive and fatal infection caused by mucor. The complex presentation of orbital apex syndrome not only poses a diagnostic challenge but also demands a multidisciplinary approach in patient management. Facial nerve palsy is an unusual presentation in orbital apex syndrome. We report the case of a 64-year-old diabetic patient presenting with ophthalmoplegia and visual loss associated with facial nerve palsy. Prompt ophthalmologic and otolaryngologic intervention with imaging and histologic confirmation, followed by early initiation of antifungal and antimicrobial therapy, were integral to preventing further complications, and reducing morbidity and mortality.

Distinct Histopathologic Features of Complicated Sinusitis.

Sinusitis complicated by intracranial or orbital extension can be life-threatening and require emergent intervention. Histologic features of complicated sinusitis have yet to be determined and may have significant implications for understanding pathophysiology. A structured histopathology report was utilized to analyze sinus tissue extracted during functional endoscopic sinus surgery (FESS). A total of 13 histopathology variables were compared between patients with complicated sinusitis (CS), CRS without nasal polyps (CRSsNP), and CRS with nasal polyps (CRSwNP). About 24 CS, 149 uncomplicated CRSsNP, and 191 uncomplicated CRSwNP patients were analyzed. Nasal tissue from CS and CRSwNP patients demonstrated similar levels of overall inflammation (66.7% vs. 69.6% with moderate/severe inflammation, P = .466). Relative to CRSsNP, CS patients showed significantly greater overall inflammation (66.7% vs. 41.6%, P = .019). CS patients demonstrated significantly fewer eosinophils per high power field (eos/HPF) and eosinophil aggregates compared to CRSwNP patients (20.8% vs. 70.7% with 5+eos/HPF, P < .0001; 4.2% vs. 33.5%, P < .0001). Relative to CRSsNP patients, CS patients demonstrated enhanced neutrophil infiltration (45.8% vs. 28.0%, P = .011). About 91.7% of CS patients demonstrated a lymphoplasmacytic predominant inflammatory infiltrate, compared to 69.8% of CRSsNP and 62.8% of CRSwNP patients (P < .0001). Significant histopathological differences were evident in patients with CS, CRSsNP, and CRSwNP. CS patients did not perfectly fit either a CRSsNP or CRSwNP profile, underscoring the importance of delineating the histopathological features of CS. This study offers insight into the histologic aspects of CS, providing initial evidence that it is an aggressive neutrophilic inflammatory process.

Ciliary function and sinonasal mucosal cytology in pediatric patients with chronic rhinosinusitis during a year after functional endoscopic sinus surgery.

The objective of the study is evaluation of ciliary function and mucosal cytology after endoscopic sinus surgery in children with chronic rhinosinusitis (CRS). A total of 132 children with CRS who underwent endoscopic sinus surgery, as well as 15 healthy controls were involved in the study. In this follow-up study patients were examined preoperatively, as well as 3, 6, 9, and 12 months after endoscopic sinus surgery. Assessment of ciliary function and sinonasal mucosal cytology was performed using high-speed videomicroscopy. Lund-Kennedy, Lund-Mackay, and sinonasal outcome test 20 (SNOT20) scores were also evaluated. Total SNOT-20, Lund-Mackay, and Lund-Kennedy values significantly decreased after sinus surgery. In contrast, ciliary function and mucosal cytology only tended to improve after 6 months. 9 months after surgery the number of ciliated cells, ciliary beat frequency, cell viability, and ciliary length were significantly higher than preoperatively. The most significant improvement of ciliary function and cell height was observed 12 months after operation, whereas epithelial dystrophy and neutrophil infiltration were significantly reduced. Substantial improvement was observed only in a year after surgery, whereas 0 to 3 months after the surgery ciliary function was severely impaired thus predisposing to recurrent sinusitis or other complications.

Pediatric subperiosteal orbital abscess characterization and prediction of size, location, and management

IntroductionSubperiosteal orbital abscess (SPOA) is a serious suppurative complication of pediatric sinusitis. The objective of this study is to stratify patient selection into those best treated medically versus surgically based on clinical outcomes. MethodsThis is a retrospective review of patients diagnosed with SPOA complicating sinusitis treated at a tertiary care pediatric hospital from 2002 through 2016. SPOA was diagnosed by CT scan. Characteristics evaluated include demographics, abscess size, location, and measurements, length of hospital stay, medical and surgical interventions, presenting symptoms, and complications. ResultsA total of 108 total SPOA secondary to sinusitis patients were included. A majority, 72.2%, were male with an average age at presentation of 6.8 years. The mean ± standard deviation abscess cubic volume was 0.98 ± 1.27 cm3 (median(range) = 0.44(0.01–7.34 cmcm3)). With an abscess volume of 0.510 cm3, there was a sensitivity of 71.2% and a specificity of 84.4% for needing surgical drainage. Those with large abscesses at our volume threshold were 13 times more likely to require surgery than those with small abscesses, OR: 13.41, 95%CI: 5.02–35.86, p < .001. Patients that required surgery had an abscess closer to the orbital apex with the majority, 25 (61.0%), being the most proximal to the apex, p = .004. The likelihood of surgery decreased with increased distance from the orbital apex in medial abscesses (OR:.92, 95%CI: 0.86-0.98, p = .009). ConclusionIn the pediatric population, SPOA is a serious consequence of sinusitis. This study provides evidence supporting that larger abscess size is a significant risk factor for requiring surgery. The appeal of our study is that it provides evidence and support that employ clinical parameters already assessed as standard practice in evaluating these patients. In summarizing the clinical translational relevance of our study, when determining whether to treat a patient with surgery and antimicrobial/medical therapy vs. non-surgical medical therapy alone, the clinician should focus on size of 0.510 cm3 or larger for abscesses in any location as a relative indication for surgery.

Bilateral Involvement of Frontal Sinuses in a Pott&amp;#39;s Puffy Tumor: A Case Report

ABSTRACT Aim and objective A case report with review of the literature. Background Pott's puffy tumor is an uncommon complication of frontal sinusitis. Nevertheless, an increase in the frequency of cases has been reported over the last 10 years. The presence of both frontal sinuses in the production of Pott's puffy tumor has never been described before. Case description A 15-year-old boy was evaluated in the emergency department by tumor and pruritus at the right frontal level. A computed tomography (CT) scan revealed a disruption of the right frontal sinus with a subperiosteal abscess. During surgery, it was discovered the involvement of both frontal sinuses. A combined bilateral functional endoscopic sinus surgery and external approach were used. Conclusion This pathology must be kept in mind in the case of an adolescent patient with a frontal tumor. Surgery is the most important factor in the treatment of this pathology together with a targeted antibiotic treatment. How to cite this article Palacios-García JM, Moreno-Luna R, Molina-Fernandez E, et al. Bilateral Involvement of Frontal Sinuses in a Pott's Puffy Tumor: A Case Report. Int J Otorhinolaryngol Clin 2019;11(3):67–69.

Pott's puffy tumor in a 23-month-old: Youngest known case of a rare disease

This case report describes a child who developed Pott's puffy tumor and was treated at the Children's Mercy Hospital in Kansas City. In addition to a discussion of a case, a review of the literature was completed on this topic describing the typical embryology and development of the frontal sinus, and the epidemiology, diagnosis, and treatment of Pott's puffy tumor. The patient was a 23-month-old boy who developed Pott's puffy tumor after recovery from influenza. The patient presented to the hospital with progressing edema of the unilateral eye that spread bilaterally within a few days. A CT scan demonstrated pansinusitis, developed frontal sinuses, right periorbital cellulitis, and medial forehead subperiosteal abscess. Functional endoscopic sinus surgery and transcutaneous abscess drainage were urgently performed and the patient made a full recovery following a course of ertapenem and levofloxacin. The presence of a developed frontal sinus in a 23-month-old is an unexpected radiologic finding. This case represents the youngest patient reported in the literature to develop this rare complication of frontal sinusitis.

A very rare complication of frontal sinusitis: Pott’s puffy tumor

Introduction. Pott’s puffy tumor is a very rare clinical condition characterized by subperiosteal abscess, a complication of frontal sinusitis, or as a result of head trauma. Aim. Early diagnosis of this condition is significantly important to prevent sequelae and severe neurological complications. This phenomenon, which is generally seen in children, can rarely be encountered in adults. Description of the case. In this report, we share a rare case of Pott’s puffy tumor in an adult patient. Conclusion. Pott’s puffy tumor, a rare complication of frontal sinusitis, should be considered to prevent neurological and intracranial complications.

A rare case of combined orbital and intracranial complications of purulent odontogenic maxilloethmoidal sinusitis

A rare case of combined orbital and intracranial complications of purulent odontogenic maxilloethmoidal sinusitis

Complications of Acute Sinusitis: A Review and Case Series

Complications of Acute Sinusitis: A Review and Case Series

Cerebral abscess and empyema complicating pansinusitis in an 11-year-old child: report of a case to the pediatrics of the Mali Hospital

Introduction: Brain abscess is an intracranial suppuration producing a newly formed cavity. Otorhinolaryngological infections are one of the main causes. We report a case of cerebral abscess and empyema complicating pansinusitis in an 11-year-old adolescent treated at the Mali Hospital. Observation: He was an 11-year-old adolescent with a history of chronic headache who was admitted for left hemiplegia. The onset dates back to around 15 days marked by an unquantified fever, headache and then coma. A brain scan performed during hospitalization revealed a brain abscess and empyema, hence its reference to the Mali Hospital. At the entrance he had a fever of 38.5 ° C and a poor general condition. He was aware, well oriented and consistent. He had flaccid left hemiplegia with preservation of peripheral sensitivity. Cardiorespiratory examination and oto-rhinolaryngological were normal. Surgical drainage associated with medical treatment including ceftriaxone 100 mg/kg/d direct intravenous for 15 days, gentamycin; 3 mg/kg/d intramuscular for 3 days, metronidazole : 10 mg/kg /12 hours intravenously slowly for 15 days, paracetamol: 15 mg/kg /6 hours intravenously slowly, glucose serum 10%: 100 ml/kg /day infused and red blood cell concentrate group O+: 20 ml/Kg intravenously slowly have been introduced. The relay was done with ciprofloxacin 10mg/Kg/12 hours for 6 weeks by oral route. The postoperative follow-up was simple. He was discharged on the 15th day of hospitalization. Conclusion: Intracranial complications of sinusitis are serious and common in children in developing countries. The brain scanner is an indispensable tool for its diagnosis. Management is multidisciplinary. Prophylaxis is based on the correct treatment of otorhinolaryngological and oral infections.