Tzelnick Sharon, Soudry Ethan, Raveh Eyal, Gilony Dror
Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center and Schneider Children's Hospital, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center and Schneider Children's Hospital, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Int J Pediatr Otorhinolaryngol. 2019 Jun;121:26-28. doi: 10.1016/j.ijporl.2019.02.037. Epub 2019 Feb 25.
Recurrent periorbital cellulitis (RPOC) associated with rhinosinusitis is rarely noted and scarcely discussed in the literature. The aim of our study was to analyze the characteristics and disease course of a group of pediatric patients with RPOC.
The medical records of all pediatric patients with a diagnosis of RPOC treated in a tertiary children's hospital were retrieved. Included were patients with a history of two or more episode of RPOC.
A total of 14 children were included. Mean follow up was 3 years (SD ± 2.5). Median age of first POC episode was 12 months (range 5 months-12 years). Overall, 75 events of RPOCs were documented. A median of 3 events per patient was noted (range 2-16). Preseptal cellulitis was diagnosed in all but five patients, in whom orbital cellulitis or subperiosteal abscess were identified, one following failure of conservative treatment, and the remaining at first presentation or recurrence. Rhinorrhea was present in only five patients (35%). The majority of patients were treated with intra-venous antibiotics. Imaging studies were performed in all patients revealing ethmoidal sinusitis in all patients, with lamina papyracea dehiscence in two patients. Immune deficiency was diagnosed in one patient. Endoscopic sinus surgery was performed in seven patients, in four as preventive procedure and in three during an acute phase. Post-operative recurrent disease was noted in two patients that were operated during the acute phase.
RPOC is a rare entity. Rhinosinusitis should be suspected in events of recurrent preseptal cellulitis even in the absence of nasal symptoms. CT scan is diagnostic for sinus origin of disease and possible anatomical abnormalities. In the majority of patients no evident etiology was identified. Elective Surgery or prophylactic antibiotic treatment should be strongly considered in this subgroup of patients as it seems beneficial.
与鼻窦炎相关的复发性眶周蜂窝织炎（RPOC）在文献中很少被提及且鲜有讨论。我们研究的目的是分析一组小儿RPOC患者的特征和病程。
检索了一家三级儿童医院收治的所有诊断为RPOC的小儿患者的病历。纳入的患者有两次或更多次RPOC发作史。
共纳入14名儿童。平均随访时间为3年（标准差±2.5）。首次眶周蜂窝织炎发作的中位年龄为12个月（范围5个月至12岁）。总体而言，记录了75次RPOC事件。每位患者的事件中位数为3次（范围2至16次）。除5名患者外，其余均诊断为眶隔前蜂窝织炎，这5名患者中，1名在保守治疗失败后被诊断为眶蜂窝织炎或骨膜下脓肿，其余4名在首次就诊或复发时被诊断为此病。仅5名患者（35%）有鼻漏。大多数患者接受了静脉抗生素治疗。所有患者均进行了影像学检查，结果显示所有患者均有筛窦炎，2名患者有纸样板裂开。1名患者被诊断为免疫缺陷。7名患者接受了鼻内镜鼻窦手术，4名作为预防性手术，3名在急性期进行。急性期手术的2名患者术后出现了疾病复发。
RPOC是一种罕见疾病。即使没有鼻部症状，复发性眶隔前蜂窝织炎发作时也应怀疑鼻窦炎。CT扫描可诊断疾病的鼻窦起源及可能的解剖异常。大多数患者未发现明显病因。对于这一亚组患者，应强烈考虑选择性手术或预防性抗生素治疗，因为这似乎有益。
