Purulent pansinusitis, orbital cellulitis and rhinogenic intracranial complications

Objectives: Acute pansinusitis is rarely seen in the maxillofacial surgery field, but often occurs in combination with orbital and intracranial involv ement. Clinically this entity is of great importance, since it represents a severe disease with possibly disastrous consequences. Patients: Aetiology, diagnosis and therapy of acute pansinusitis and its complications were ana lysed in 36 patients treated surgically from 1987 to 1996, Results: Eightee n patients were aged between 3 and 21-years-old. Only eight suffered from p ure pansinusitis, and three of an isolated purulent orbital infection. Of t hese 25 patients 20 had (pan-)sinusitis with orbital, three with intracrani al, and two with both orbital and intracranial complications. Intracranial involvement included meningitis, empyema and brain abscess. Aetiology was r hinogenic in 26, odontogenic in six patients, and traumatic in two cases. R adiological work-up included conventional radiographs and CT in most cases, MRI was only used with special indications. Microbiological examination de tected single or multiple species of micro-organisms with equal frequency. If multiple species were found, infection was mostly aerobic/anaerobic in c ombination. Conclusion: These purulent processes, frequently seen in young patients, require immediate surgical intervention and drainage with elimina tion of the cause of the disease if possible. Cooperation with other specia lities is essential depending on the spread of the disease. In spite of the threatening acute symptoms, severe courses of disease or permanent defects should be avoidable. (C) 2001 European Association for Cranio-Maxillofacia l Surgery.