Osteomyelitis

It is the infection of bone marrow.

- It is seen in infants and children than adults because of presence of spongy bone in anterior wall of maxilla. Infection may start in dental sac and then spread to the maxilla, but less often it is primary infection of maxillary sinus.

Clinical Features: Erythema, Swelling of cheek, oedema of lower lid, purulent nasal discharge and fever.

Subperiosteal abscess followed by fistulae may form in infraorbital region, alveolus or palate or in zygoma.

Treatment- large doses of antibiotics, drainage of any abscess and removal of sequestra.

2. - More often seen in

adults.

Results from acute infection of frontal sinus either directly

or through the venous spread. It can also follow trauma or

surgery of frontal sinus in the presence of acute infection.

Pus may form externally under the periosteum as soft

doughy swelling, or internally as extradural abscess.

Treatment- large doses of antibiotics, drainage of abscess

and trephening of frontal sinus through its floor.

Orbital Complications

The orbit is the structure most commonly involved in

complicated sinusitis.

Orbital extension is usually the result of ethmoid sinusitis.

Children are more prone to orbital complications,

probably secondary to high incidence of URI and

sinusitis.

Subperiosteal abscess

Pus collects outside the bone under the periosteum.

A subperiosteal abscess from ethmoids forms on the

medial wall of orbit and displaces the eyeball forward,

downward and laterally.

From the frontal sinus, abscess is situated just above

and behind the medial canthus and displaces eyeball

downwards and laterally

From the maxillary sinus, abscess forms in the floor of

the orbit and displaces the eyeball upwards and

forwards.

Orbital Cellulitis

When pus breaks through the periosteum and finds its

way into the orbit, it spreads between the orbital fat,

extraocular muscles, vessels and nerves.

Clinical features will include oedema of lids,

exophthalmos, chemosis of conjunctiva and restricted

movements of the eye ball. Vision is affected causing

partial or total loss which is sometimes permanent.

Patient may run high fever.

Orbital cellulitis is potentially dangerous because of the

risk of meningitis and cavernous sinus thrombosis.

Orbital Abscess

Intraorbital abscess usually forms along lamina

papyracea or the floor of frontal sinus.

Clinical picture is similar to that of orbital cellulitis.

Diagnosis can be easily made by CT scan or ultrasound

of the orbit.

Treatment is i.v. antibiotics and drainage of the abscess

and that of the sinus (ethmoidectomy or trephination of

frontal sinus).

Superior orbital Fissure syndrome

Infection of sphenoid sinus can rarely affect structures

of superior orbital fissure. Symptoms consist of deep

orbital pain, frontal headache and progressive paralysis

of CN VI, III and IV, in that order.

Orbital apex Syndrome

It is superior orbital fissure syndrome with additional

involvement of the optic nerve and maxillary division of

the trigeminal (V2)