Proptosis in pediatrics
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Proptosis in pediatrics

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Proptosis in pediatrics Presentation Transcript

  • 1. PROPTOSIS IN PEDIATRIC PATIENTS prospective study by DR VIJAYLAXMI SHRIVASTAVA DR G. MALINI JAWAHARLAL NEHRU HOSPITAL & RESEARCH CENTRE STEEL PLANT HOSPITAL
  • 2. INTRODUCTION• ANTERIOR DISPLACEMENT OF GLOBE OF EYE BY >20 mm• >2mm DIFFERENCE BETWEEN APEX OF CORNEA OF TWO EYES• CHILD WITH PROPTOSIS IS GROTESQUE TO LOOK AT
  • 3. INTRODUCTION PERMANENT SEQUELAE• CORNEAL ULCERATION• CORNEAL OPACITY• OPTIC ATROPHY• BLINDNESS
  • 4. INTRODUCTION OTOLARYNGOLOGIST OPTHALMOLOGIST ONCOLOGISTRADIOLOGIST PROPTOSIS CLINICIAN PATHOLOGIST NEUROSURGEON
  • 5. AIMS & OBJECTIVESTO ANALYSE• INCIDENCE• ETIOLOGICAL FACTORS• CORRELATION WITH INVESTIGATIONAL MODALTIES• MANAGEMENT & OUTCOME OF CHILDHOOD PROPTOSIS
  • 6. MATERIALS & METHODS• PROSPECTIVE STUDY• DURATION:THE CALENDER YEAR 2007.• CASES WITH PROPTOSIS ADMITTED IN THE PEDIATRICS WARD DURING ABOVE PERIOD
  • 7. MATERIALS & METHODS• HISTORY• EXAMINATION• INVESTIGATION• MANAGEMENT• FOLLOW UP
  • 8. OBSERVATIONS AGE DISTRIBUTION 2NUMBER 1 0 6 MONTHS 4 YEAR 8 YEAR 9 YEAR 13 YEAR MOST CASES WERE TODDLERS - 4/7
  • 9. OBSERVATIONS CONTD SEX DISTRIBUTION 2 FEMALE MALE 5• TOTAL n= 7• MALE 5/7
  • 10. OBSERVATIONS CONTD: 2 BILATERAL UNILATERAL 5• TOTAL n=7
  • 11. PRESENTING COMPLAINTS765432 5 51 3 20 HEADACHE PAIN FEVER VOMITING
  • 12. DURATION OF COMPLAINTS 15 14 15 13 12 12 11 10 10 9 8DAYS 8 7 7 6 5 4 5 3 2 2 1 0
  • 13. PREDISPOSING FACTORSINUSITIS-ETHMOIDAL, 3SPHENOIDAL, & MAXILLARYFURUNCULOSIS OF NOSE 1UPPER RESPIRATORY TRACT 1INFECTIONDENTAL CARIES 1CONJUCTIVITIS 1
  • 14. SIGNS7 765 4 44 3 33 22 110 LID EDEMA CHEMOSIS MENINGEAL 6 N PALSY 4 N PALSY 3 N PALSY SIGNS CONVULSI ON
  • 15. PUPILLARY REACTION 4 3 4/7NORMALDILATED & SLUGGISH REACTION TO LIGHT
  • 16. FUNDUS EXAMINATION 3 3/74 NORMAL PAPILLEDEMA
  • 17. INVESTIGATIONS• HEMOGRAM• BLOOD CULTURE & SENSITIVITY• PUS/SWAB CULTURE & SENSITIVITY• CT SCAN HEAD
  • 18. INVESTIGATIONSSPECIAL• COAGULATION PROFILE• MANTOUX TEST• ELECTROPHORESIS• CSF STUDY• PROTEIN C ,PROTEIN S LEVELS
  • 19. ETIOLOGY5 3 ORBITAL CELLULITIS WITH 3 3 SINUSITIS WITH CAVERNOUS SINUS4 THROMBOSIS ORBITAL CELLULITIS3 1 RHABDOMYOSARCOMA2 PROTHROMBOTIC DISORDER10
  • 20. CAVERNOUS SINUS THROMBOSIS
  • 21. ORBITAL CELLULITIS
  • 22. RHABDOMYOSARCOMA
  • 23. MANAGEMENT• CONSERVATIVE• SURGICAL INTERVENTION• CHEMOTHERAPY
  • 24. CONSERVATIVE MANAGEMENT• MANAGEMENT OF SHOCK• AGGRESSIVE ANTIBIOTIC COVERAGE• TOPICAL ANTIBIOTICS & EYE CARE• LMWH(ENOXAPARIN)- IN 1 CASE OF CAVERNOUS SINUS THROMBOSIS• SUPPORTIVE THERAPY
  • 25. ONCOLOGICL MANAGEMENTCHEMOTHERAPY VAC - VINCRISTINE -ACTINOMYCIN - CYCLOPHOSPHAMIDE
  • 26. SURGICAL MANAGEMENT• INCISION & DRAINAGE OF ABSCESS• CRANIOTOMY & EVACUATION OF PUS• SINUS DRAINAGE• EXTRACTION OF CARIES TEETH
  • 27. COMPLICATIONSCOMPLICATIONS RATE OTHER OUR STUDIES STUDYVISUAL IMPAIRMENT 10-30% 14%CAVERNOUS SINUS 40% 42%THROMBOSISNEUROLOGICAL 50% 14%DEFICIT
  • 28. NO COMPLICATIONS ON FOLLOW UP
  • 29. CRANIAL NERVE PALSY WITH VISUAL IMPAIRMENT
  • 30. DISCUSSION STUDY COMPARISON DATAMALE 2.5:1 AGRAWAL 1.9%:FEMALE etal(1979)RATIO BELMEKKI 2% (1999) NAGESWARAN 2.7%. etal(2006) SEEMA etal (2006) 1.6%
  • 31. DISCUSSION STUDY COMPARISON DATAAGE LESS 57% AGRAWAL 60%THAN 5 etal(1979)YEARSUNILATERA 71% MERCHANT etal 68%L (1993)
  • 32. DISCUSSIONRISK STUDY COMPARISON DATASINUSITIS 42% RODRIQUEZ 68% etal(2000)LID & FACE 28 % RODRIQUEZ 28 %INFECTION etal(2000)
  • 33. DISCUSSION STUDY COMPARISON DATAINFLAMMATO 71% SINDHU etal(1998) 39%RY ETIOLOGY MAJEKODUNMI 52%. etal (NIGERIA 1982)
  • 34. DISCUSSION STUDY COMPARISON DATABLOOD 14% SEAN etal (1998) 10%CULTURE GOMEZ 23% etal(1996).
  • 35. DISCUSSION STUDY COMPARISON DATASURGERY 57% NAGESWARAN etal 71% (2006).
  • 36. CONCLUSION• NOT UNCOMMON• INFLAMMATION FROM ADJACENT SITE• CAVERNOUS SINUS THROMBOSIS FREQUENT HIGH MORTALITY
  • 37. CONCLUSION• PERMANENT DEFICIT• PROTHROMBOTIC STATES COEXISTS
  • 38. CONCLUSIONEARLY & PROMPT THERAPY LEADS TOCOMPLETE RECOVERY & SATISFYINGOUTCOME