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Orbital Cellulitis
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com

www.indiandent...
Orbit anatomy
Frontal

Sphenoid

Nasal
Ethmoid
Lacrimal

Zygoma
Maxillary
www.indiandentalacademy.com
Orbital Cellulitis
Orbital cellulitis is a dangerous infection with
potentially serious complications
It is usually caused...
Children
 In

children, orbital cellulitis is usually from a
sinus infection and due to the organism
Hemophilus influenza...
Pathophysiology
 extension

of infection from the periorbital structures,
most commonly from the paranasal sinuses, but a...
Orbital septum







The orbit is separated from the soft tissue of the eyelid by
the orbital septum. This is a fasci...
Orbital septum

www.indiandentalacademy.com
Orbital vs. Preseptal Cellulitis
 Orbital

cellulitis is infection of the soft
tissues of the orbit posterior to the orbi...
Chandler Classification
Stage I
Preseptal
Stage II
Stage III
Stage IV
Stage V

Inflammatory edemaOrbital cellulitis - Post...
Symptoms











Fever, generally 102 degrees F or greater.
Painful swelling of upper and lower lids (upper i...
Complications
 Subperiostal/Orbital

abscess (Chandler III-IV)
 Cavernous sinus thrombosis
 Hearing loss
 Septicemia o...
A male with orbital cellulitis with proptosis,
ophthalmoplegia, and edema and erythema of the eyelids
www.indiandentalacad...
www.indiandentalacademy.com
Non-surgical treatment
 IV

ABx
 Antifungals (if indicated)
 Nasal decongestants (open sinus ostia)
 Duretics – DIAMOX...
Surgical Treatment
1.

2.

3.

4.

5.

Surgical drainage if the response to appropriate antibiotic
therapy is poor within ...
? How
 Superior

orbit decompression
 Medial orbit decompression
 Inferior orbit decompression
 Lateral orbit decompre...
Superior Orbit Decompression
 Frontal

cranioitomy –
unroofing of superior
wall of orbit
 Titanium sheild placed
to supp...
www.indiandentalacademy.com
Medial Orbit Decompression
 External

ethmoidectomy incision or coronal
forehead approach
 External ethmoidectomy- compl...
Inferior Orbit Decompression
 Orbital

floor blow-out fracture , but spares
infraorbital nerve
 Subcilliary eyelid incis...
Lateral Orbit Decompression
 Lateral

canthotomy
 Removal of lateral orbital bone posterior to the
rim
 Orbital fat pro...
An incision extending from the lateral canthus to the
area just below the inferior punctum is created 4 mm to
5 mm below t...
www.indiandentalacademy.com
Intranasal approach
 Decompression

of medial anf medioinferior

floors of orbit
 Endoscopic sinus surgery technique
 A...
Thank you
For more details please visit
www.indiandentalacademy.com

www.indiandentalacademy.com
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orbital cellulitis / DENTAL COURSES certified fixed orthodontic courses,oral surgery courses,dental implant courses,prosthodontic courses,dental courses,rotary endodontic courses, dental crown & bridge courses,cosmetic dentistry courses

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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.


Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
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orbital cellulitis / DENTAL COURSES certified fixed orthodontic courses,oral surgery courses,dental implant courses,prosthodontic courses,dental courses,rotary endodontic courses, dental crown & bridge courses,cosmetic dentistry courses

  1. 1. Orbital Cellulitis INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  2. 2. Orbit anatomy Frontal Sphenoid Nasal Ethmoid Lacrimal Zygoma Maxillary www.indiandentalacademy.com
  3. 3. Orbital Cellulitis Orbital cellulitis is a dangerous infection with potentially serious complications It is usually caused by a bacterial infection from the sinuses (mainly ethmoid, accounting for more than 90% of all cases) Other causes :a stye on the eyelid, recent trauma to the eyelid including bug bites, or a foreign object www.indiandentalacademy.com
  4. 4. Children  In children, orbital cellulitis is usually from a sinus infection and due to the organism Hemophilus influenzae (decrease in incidence after vaccination program implentation).  Other organisms are Staphlococcus aureus, Streptococcus pneumoniae, and Beta hemolytic streptococci www.indiandentalacademy.com
  5. 5. Pathophysiology  extension of infection from the periorbital structures, most commonly from the paranasal sinuses, but also from the face, globe, and lacrimal sac  direct inoculation of the orbit from trauma or surgery (orbital decompression, dacryocystorhinostomy, eyelid surgery, strabismus surgery, retinal surgery, and intraocular surgery, have been reported as the precipitating cause of orbital cellulitis)  hematogenous spread from bacteremia www.indiandentalacademy.com
  6. 6. Orbital septum     The orbit is separated from the soft tissue of the eyelid by the orbital septum. This is a fascial plane that is continuous with the periosteum of the facial bones. The orbital septum inserts into the tarsal plate of the upper and lower eyelids. The orbital septum usually proves to be an effective barrier that prevents the spread of infection from the eyelids posteriorly to the orbit. While preseptal cellulitis can occasionally spread to the orbital contents, it is generally a clinical entity that is distinct from orbital cellulitis www.indiandentalacademy.com
  7. 7. Orbital septum www.indiandentalacademy.com
  8. 8. Orbital vs. Preseptal Cellulitis  Orbital cellulitis is infection of the soft tissues of the orbit posterior to the orbital septum, differentiating it from preseptal cellulitis, which is infection of the soft tissue of the eyelids and periocular region anterior to the orbital septum  DD: orbital pseudotumor (inflammatory condition, responds to steroids) www.indiandentalacademy.com
  9. 9. Chandler Classification Stage I Preseptal Stage II Stage III Stage IV Stage V Inflammatory edemaOrbital cellulitis - Postseptal Subperiostal abscess Orbital abscess Complication due to posterior extension www.indiandentalacademy.com
  10. 10. Symptoms           Fever, generally 102 degrees F or greater. Painful swelling of upper and lower lids (upper is usually greater). Eyelid appears shiny and is red or purple in color. Infant or child is acutely ill or toxic. Eye pain especially with movement. Decreased vision (because the lid is swollen over the eye). Eye bulging (forward displacement of the eye). Swelling of the eyelids General malaise. Restricted or painful eye movements www.indiandentalacademy.com
  11. 11. Complications  Subperiostal/Orbital abscess (Chandler III-IV)  Cavernous sinus thrombosis  Hearing loss  Septicemia or blood infection  Meningitis  Optic nerve damage and blindeness www.indiandentalacademy.com
  12. 12. A male with orbital cellulitis with proptosis, ophthalmoplegia, and edema and erythema of the eyelids www.indiandentalacademy.com
  13. 13. www.indiandentalacademy.com
  14. 14. Non-surgical treatment  IV ABx  Antifungals (if indicated)  Nasal decongestants (open sinus ostia)  Duretics – DIAMOX (carbonic anhydrase inhibitor), mannitol (reduce IOP) www.indiandentalacademy.com
  15. 15. Surgical Treatment 1. 2. 3. 4. 5. Surgical drainage if the response to appropriate antibiotic therapy is poor within 48-72 hours or if the CT scan shows the sinuses to be completely opacified. Consider orbital surgery, with or without sinusotomy, in every case of subperiosteal or intraorbital abscess formation. Surgical drainage of an orbital abscess is indicated if any of the following occurs: decrease in vision, An afferent pupillary defect. proptosis progresses despite appropriate antibiotic therapy The size of the abscess does not reduce on CT scan within 48-72 hours after appropriate antibiotics have been administered. If brain abscesses develop and do not respond to antibiotic therapy, craniotomy is indicated. www.indiandentalacademy.com
  16. 16. ? How  Superior orbit decompression  Medial orbit decompression  Inferior orbit decompression  Lateral orbit decompression  Intranasal approach www.indiandentalacademy.com
  17. 17. Superior Orbit Decompression  Frontal cranioitomy – unroofing of superior wall of orbit  Titanium sheild placed to support the frontal lobe of the brain  High morbidity, consider only for severe cases www.indiandentalacademy.com
  18. 18. www.indiandentalacademy.com
  19. 19. Medial Orbit Decompression  External ethmoidectomy incision or coronal forehead approach  External ethmoidectomy- complete ethmoid sinus resection, then orbital fat herniates into sinus defect  Coronal incision- ethmoidectomy via a superior approach, more risk for lacrimal sac and trochlea injury www.indiandentalacademy.com
  20. 20. Inferior Orbit Decompression  Orbital floor blow-out fracture , but spares infraorbital nerve  Subcilliary eyelid incision or Caldwell-Luc incision  Combined approach?  Intraorbital fat herniates maxillary sinus www.indiandentalacademy.com
  21. 21. Lateral Orbit Decompression  Lateral canthotomy  Removal of lateral orbital bone posterior to the rim  Orbital fat protrudes the newly created space www.indiandentalacademy.com
  22. 22. An incision extending from the lateral canthus to the area just below the inferior punctum is created 4 mm to 5 mm below the lower border of the tarsal plate to avoid injury to the septum and the canaliculus www.indiandentalacademy.com
  23. 23. www.indiandentalacademy.com
  24. 24. Intranasal approach  Decompression of medial anf medioinferior floors of orbit  Endoscopic sinus surgery technique  Anterior Ethmoidectomy  Maxillary antrostomy www.indiandentalacademy.com
  25. 25. Thank you For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com

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