Orbital abscess after facial trauma

[Interdisciplinary Management of Orbital Diseases]

Diagnosis and therapy of orbital diseases is an interdisciplinary challenge, in which i.e. otorhinolaryngologists, ophthalmologists, radiologists, radiation therapists, maxillo-facial surgeons, endocrinologists, and pediatricians are involved. This review article describes frequent diseases which both, otolaryngologists and ophthalmologists are concerned with in interdisciplinary settings. In particular the inflammatory diseases of the orbit including orbital complications, autoimmunological diseases of the orbit including Grave´s orbitopathy, and primary and secondary tumors of the orbit are discussed. Beside describing the clinical characteristics and diagnostic steps the article focusses on the interdisciplinary therapy. The review is completed by the presentation of most important surgical approaches to the orbit, their indications and possible complications. The authors tried to highlight the relevant facts despite the shortness of the text.

Orbital Abscess—Two Case Reports with Review

Periorbital infections lead to severe condition of the orbital abscess, and eventually to sight loss, and even death. Current study aims in reviewing the literature regarding orbital abscess in adult patients and presenting 2 original cases. A surgical intervention to drain the abscess and a revision of the orbital was required. A review of literature is also reported focusing on aetiology and treatment options dealing with an orbital abscess.

Post-traumatic Orbital Abscess in an Adult With No Evidence of Orbital Fracture, Paranasal Sinusitis, or Foreign Body Migration

A 35-year-old man was hit against his left eye by his child’s foot. Two days following trauma, the patient noticed diplopia in the upward and right gazes. On the first examination seven days after trauma, computed tomographic (CT) images revealed a small mass in the inferolateral orbit near the inferior orbital fissure. There was no radiological evidence of orbital fracture, paranasal sinusitis, or foreign body. Immediately after the first examination, the patient had a history of fever, retrobulbar pain, and nausea. These symptoms gradually worsened, and the patient visited the emergency department of our hospital at 13 days following trauma. CT images showed enlargement in the size of the mass. The diagnosis of the orbital abscess was made, and emergent drainage of the abscess was performed, followed by administration of intravenous antibiotics. On the fifth postoperative day, cultures of the abscess specimen showed growth of Fusobacterium nucleatum (4+), Parvimonas micra (4+), and Prevotella intermedia (4+). The patient’s condition improved significantly and at the 1.5-month follow-up, the patient did not have any symptoms related to the orbital abscess.

[Orbital complications]

A disease or symptom of disease spreading from the vicinity of the orbit to the internal structures of the orbit is referred to as an orbital complication. Orbital complications can have a traumatic, inflammatory, allergic, or autoimmunologic cause. They are more frequent in children than adults. The present review aims to provide a description of orbital complications, their etiology, pathogenesis, and treatment. Recent literature in the field is acknowledged and discussed, and results from the authors' own patient groups are analyzed. Particular attention is paid to orbital complications due to acute sinusitis and those caused by acute hemorrhage. The term "orbital phlegmon" frequently used for orbital complications with inflammatory causes is confusing and should be replaced by differentiated grading. Diagnosis and treatment of orbital complications requires interdisciplinary collaboration, whereby inclusion of ophthalmologists is particularly important. Treatment of orbital complications depends on their cause. In inflammatory cases affecting only the preseptal tissues and compartment, conservative therapy is indicated. If clinical findings worsen within 24 h of conservative therapy, or if the patient presents with a high-grade orbital complication with loss of visual acuity or impairment of globe mobility, surgery is required. In cases of acute hemorrhage into the orbit, a procedure for decreasing intra-orbital pressure is mandatory (i. e., canthotomy, cantholysis, orbital decompression).

Functional Endoscopic Surgery After Facial Trauma

The present study describes 3 patients of previous facial trauma who have subsequently been treated with functional endoscopic sinus surgery. The authors want pay attention on the possible correlation between facial trauma and sinusitis. Such fractures can be the cause of onset of paranasal sinusitis or of worsening of a previous sinusitis. The correlation between these 2 pathologies could be due to the fact that facial fractures concern the anatomic structures of paranasal sinuses. The damage to these structures during the facial trauma and tissue regeneration after injury or surgical treatment subverts the anatomy and function of the sinuses in a basically compromised situation.