Fact-sheet: Sinusitis ou ethmoiditis
Updated on 09/17/2021 at 12:16 PM
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Definition
Bacterial infection of the ethmoidal labyrinth cells
Mainly affects young children
Clinical features
Clinical diagnosis:
-Edema of the medial canthus, upper eyelid edema
-Nasal obstruction, rhinorrhea
-Fever
Good prognosis if confined to the preseptal space
Risk of spread to the orbital cavity, posterior intracranial extension
Functional and vital risk if retroseptal extension:
Exophthalmos
Oculomotor paralysis
Decreased visual acuity
Laboratory findings
inflammatory syndrome
Ultrasound
Indicated for the workup of intraorbital abscess!
CT
Indications for contrast-enhanced CT (or MRI if available):
-Suspected complicated ethmoiditis with intraorbital involvement
-Chandler stage >or=3:
Impaired ocular motility
-Decreased visual acuity, diplopia
-Non-reducible exophthalmos
In practice, it is preferable to obtain a CT scan rather than miss the diagnosis of retro-septal involvement, but the CT must be performed under proper conditions, i.e., with iodinated contrast ++
-Isolated chemosis is not an indication
CT features:
-Infiltration of the medial canthus without intraorbital involvement (pre-septal ethmoiditis)
-Opacification of the ethmoidal cells
-Bone lysis involving the ethmoidal labyrinth
Complications to look for:
-Subperiosteal intraorbital abscess: splitting of the medial orbital wall,
displacement of the orbital cone, and exophthalmos
-Abscess of brain
-Subdural empyema
-Cavernous sinus thrombophlebitis
Management
Treatment:
-Simple ethmoiditis: intravenous antibiotic therapy
-Collection: warrants image-guided surgical drainage.
