Anatomical features in children with orbital complications due to acute rhinosinusitis

Abstract

Objective: To investigate the relationship between anatomical landmarks identified by computed tomography (CT) and the severity of orbital complications of acute rhinosinusitis (ARS) in the pediatric population.

Materials and Methods: A retrospective study was conducted between 2012 and 2022 in children with a clinical and imaging diagnosis of complicated acute rhinosinusitis (ARS). Computed tomography (CT) scans of the paranasal sinuses were analyzed to assess the Lund-Mackay score, obstruction of the ostiomeatal complex (OMC), and the presence of anatomical landmarks (agger nasi, concha bullosa, infraorbital and Onodi cells, nasal septal deviation, inferior turbinate hypertrophy, and lamina papyracea dehiscence). Orbital complications were classified according to the Chandler scale.

Results: A total of 86 children were included. A significant difference was observed in the Lund-Mackay score between the side with the complication (mean: 6.3) and the contralateral side (mean: 4.7; p < 0.001). The coexistence of two or more anatomical landmarks on the affected side was significantly more frequent (p < 0.01). No isolated anatomical landmark showed a statistically significant association with clinical severity. The combination of agger nasi, infraorbital cells, and concha bullosa was correlated with increased severity of orbital complications (Chandler ≥ II; p = 0.0431).

Conclusion: The combined presence of specific anatomical landmarks — particularly agger nasi cells, infraorbital cells, and concha bullosa — is associated with more severe forms of orbital complications in children with acute rhinosinusitis (ARS). Detailed CT evaluation may be crucial for risk stratification and early definition of the therapeutic approach.