28. Phlegmon of the orbital area. Topographic and surgical anatomy, etiology, clinical features, diagnosis, differential diagnosis and treatmen

Question 1

How orbital infection classified

Answer 1

• Group 1: Inflammatory Edema=>
• Upper eyelid edema, normal extraocular movement, and normal vision
  Group 2: Orbital Cellulitis=>
• Severe, non-suppurative periorbital edema, proptosis, chemosis, impaired extraocular muscle function
• Group 3=> Subperiosteal Abscess=> collection of pus at the medial aspect of the orbit=>
• impaired extraocular muscle function, and changes in visual acuity
  Group 4: Orbital Abscess=> abscess within the orbit=>
• Severe proptosis, complete visual impairment
• Group 5: Cavernous Sinus Thrombosis=> Sepsis, orbital pain, chemosis, proptosis, and ophthalmoplegia.

-Chemosis (or conjunctival chemosis) is a blister-like swelling of the conjunctiva
-Proptosis- Bulging eyes, also called exophthalmos or proptosis, is when one or both of your eyes protrude from their natural position
-Ophthalmoplegia is the paralysis or weakness of the eye muscles

Question 1

The major complications associated with sinusitis related to the orbital area

Answer 1

• Include orbital and intracranial complications=>
• Due to the close proximity of the paranasal sinuses and the thin lamina papyracea
• Valveless superior and inferior ophthalmic veins=> allows communication to and from the nose, ethmoids, face, orbit, and cavernous sinus=>
• Spread of infection.

Lamina papyracea=> Separates the ethmoids from the orbit.

Question 2

Causes of orbital cellulitis

Answer 2

• Infection from periorbital structures=> paranasal sinuses
• Direct bacterial inoculation=>trauma, surgery, or hematogenous spread of infection
• Odontogenic infections, maxillary osteomyelitis, and dental extractions

Question 3

Clinical features of orbital cellulitis

Answer 3

• Painful and erythematous swelling of the eyelid
• Fever
• Proptosis, conjunctivitis, and chemosis
• Impaired movement of the eye
• Signs of optic nerve damage

Question 4

How orbital cellulitis diagnosed and treated

Answer 4

• A CT scan
• Treatment=> Aggressive treatment w/ antibiotics
• Sometimes surgical intervention=>Drain abscesses and alleviate pressure

Question 5

Cavernous sinus thrombosis and its etiology

Answer 5

• Bacterial infections spreading from the paranasal sinuses, ears, eyes, nose, or facial skin
• An abscess in the maxillofacial region may also be involved

Question 6

Cavernous sinus thrombosis clinical features

Answer 6

• Abrupt onset of unilateral periorbital edema
• Headache, inability to move the eye, loss of vision
• Cranial nerve involvement=> ophthalmoplegia
• Severe systemic illness=> fluctuating fever

Question 7

Cavernous sinus thrombosis Diagnosis

Answer 7

• Sinus radiography
• CT scan
• MRI
• Clinical presentation

Question 8

Treatment approach for cavernous sinus thrombosis

Answer 8

• Aggressive Medical Treatment:=>broad-spectrum
• Surgical Intervention=> drainage