Proptosis in pediatrics

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Proptosis in pediatrics

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

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