13. Chandler´s classification Bilateral eye findings and worsening of all other previously described findings. V. Cavernous sinus thrombosis Discrete pus collection in orbital tissues, proptosis and chemosis with ophthalmoplegia and decreased vision. IV. Orbital abscess Collection of pus between medial periosteum and lamina papyracea, impaired extraocular movement. III. Subperiosteal abscess Diffuse orbital infection and inflammation without abscess formation. II. Orbital cellulitis (postseptal) Lid edema, no limitation in ocular movement or visual change. I. Inflammatory edema (preseptal)
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30. Transcaruncular approach Bailey, BJ (2006). Head & Neck Surgery - Otolaryngology. 4th ed. Philadelphia: Lippincott Williams & Wilkins. 499.
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35. Ebright JR, Pace MT, Niazi AF. Septic thrombosis of the cavernous sinuses. Arch Intern Med 2001;161:2671-2676.
45. Intracranial abscess ESS / Neurosurgery (stereotactic vs. open) IV Abx., craniotomy, ESS, anticonvulsivants, +/- steroids IV Abx. + Surgery (craniotomy / ESS) Treatment MRI (T2) Hypointense with capsule CT may show it but MRI is better CT or MRI Diagnosis Subtle if frontal (mood) H/A, lethargy, seizures, focal deficits Meningismus, rapid progression to coma Mild, non-specific for weeks. Increase ICP Symptoms Asymptomatic phase while it coalesces Spreads diffusely convexities, interhemispheric Slow expanding Progression Frontal/frontopariental white/gray matter Subdural space no boundaries Between skull and dura Location Intracranial Subdural Epidural *
CT was initial test always. Obtained in first 48h in all pt. MRI only obtained when there was clinical suspition of intracranial complication or failure to improve to medical therapy. Indications for surgery (abscess suspected, or failure to improve after 24h of abx.)
Authors recommeded MRI in addition to CT along with aggressive management in children older than 7. Age of frontal being radiologicaly present
15 to 30% of patients will develop various visual sequelae, despite aggressive medical and surgical intervention.
Suggesting younger children have less virurent infections than older children. Even though there is high variavility in studies… these are inclussion criteria suggested for medical management:
In contrast to other series… Criteria for medical management… In conclusion there is a subset of pt that can be treated medically (as long as there is close ophto/otorrino f/u)
Surgical approaches to drain a PTA include external, endoscopic and combined.
Combined approaches have the advantage of preserving lamina. Keeping separate compartments. This technique useful when FRONTAL also involved.
Say the nerves after 2.
Otolaryngol Head Neck Surg 2003
No concensus on timing of sinus surgery ( no controlled trials)
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