Endoscopic Management of Mucoceles With Significant Orbital Involvement

Abstract

Abstract: The incidence of serious complications from acute rhinosinusitis has been estimated to be 1:12,000 in children and 1:32,000 in adults. Orbital complications are more common than intracranial complications and most commonly occur in male children. Most orbital complications occur from an infected ethmoid sinus. Subperiosteal abscesses (SPAs) of the orbit most commonly affect the medial wall but can also involve the inferior and superior orbital walls. Initial workup includes a full ophthalmologic evaluation. If there is a concern for an orbital complication beyond preseptal cellulitis, computed tomography of the sinuses, preferably with contrast, is the investigation of choice. Management of SPAs with endonasal endoscopic techniques has decreased the morbidity of surgery. Younger patients with smaller abscesses may be treated initially with medical therapy and close observation, but any patient whose condition does not improve after 48 to 72 hours requires operative drainage. Surgeons should be prepared for increased blood loss and inflamed mucosa that can make the approach challenging. Management of SPAs requires a multidisciplinary team.