CLINICAL ASPECTS PECULIAR ASPECTS OF INFLAMMATORY SINO-ORBITAL SYNDROME IN CHILDREN KARIN HORVATH 1 , GH. MŰHLFAY², DIANA CONSTANTINESCU 3 , FLORINA VULTUR 4 1,3,4 Oftlamologic Ckinic, Tg-Mureş, ²ORL Clinic, Tg-Mureş Keywords: ocular orbital complications, sinusitis Abstract: Purpose: the paper emphasizes an interdisciplinary pathology of sinus etiology with orbital involvement which often raises issues regarding the solving of the cases in due time. Material and method: it is reported a group of 8 children between 3 and 18 years-old, with different ophthalmologic diagnosis (orbital cellulitis, phlegmon, dacryocystitis, retrobulbar optic neuritis) but they all suffered from severe paranasal sinusitis. The management of the cases and the most efficient treatment are described. Results: at first, due to the ophthalmologic manifestation of the disease, the children usually go to the ophthalmologist, who initiates an examination strategy as well as an initial treatment. Along with the radioimagistic diagnosis of a paranasal sinusitis, mostly ethmoidal in children’s case, the ENT specialist takes under consideration the drainage of the sinus infection. All interventions were done by FESS method and had excellent results. Conclusions: keeping in mind that most of the time there are major emergencies lives threatening for the children, the ophthalmologist must be able to establish a probable diagnosis in due time and send the child to a paraclinical, interclinical consult (CT, ENT) qualified in solving such a case. Cuvinte cheie: complicaţii orbitare oculare, sinuzite Rezumat: Scopul lucrării:lucrarea se adresează unei patologii interdisciplinare, de etiologie sinusală cu implicaţie orbitară, care ridică adesea probleme în ceea ce priveşte rezolvarea în timp util a cazurilor. Material şi metodă: se prezintă un lot de 8 copii cu vârste cuprinse între 3 şi 18 ani, cu diagnostice oftalmologice diverse (celulită orbitară, flegmon, dacriocistită, nevrită optică retrobulbară), dar care prezentau cu toţii sinuzite paranazale grave. Se descrie managementul cazurilor, respectiv cel mai eficient tratament. Rezultate: datorită manifestării în primul rând oftalmologice a bolii, copiii se prezintă de regulă la oftalmolog, acesta fiind cel care iniţiază o strategie investigaţională, precum şi un tratament de debut. Odată cu diagnosticarea radioimagistică a unei sinuzite paranazale, cel mai frecvent etmoidale în cazul copiilor, s-a luat în considerare drenajul focarului de infecţie sinusal de către specialistul ORL. Toate intervenţiile s-au efectuat prin metoda FESS, cu rezultate excelente. Concluzii: fiind vorba de multe ori de urgenţe majore, cu pericol vital la copil, oftalmologul trebuie să fie în măsură să stabilească în timp util un diagnostic de probabilitate orientând copilul către consulturile paraclinice, interclinice (CT, ORL) competente în rezolvarea cazului. INTRODUCTION Sino-orbital syndrome shows a rhino-neuro- ophthalmologic condition, simultaneously or successively, clinical and imagistic diagnosed and FESS (Functional Endoscopic Sinus Surgery) approached. It is a rhino-sino- orbital-ocular intricate pathology of different etiology (infectious, tumors, trauma etc.) with multiple forms of manifestation, firstly characterized by the prevalence of ophthalmologic clinical findings, presenting onwards a variability of different symptomatology. In the end it benefits mostly from oto-rhino-laryngological treatment. The etiology can be structured into the following pathogenic groups: 1. Predisposed variations of development 2. Local or regional trauma 3. Thyroid determination 4. Inflammatory diseases 5. Infectious diseases 6. Tumor’s origin of supra-, meso- and infra-structure 7. Complex (by the addition of those above) The spread pathways are classified into: • direct, in case of bony dehiscence • venous, the orbital veins being nonvalvular or with a hypoplasic valvular system • arterial, virtually of no significant importance and • lymphatic, although the lymphatic system is poorly represented into the orbit. The predisposed anatomic and functional conditions are: • the existence of natural partitions (fissures, orifices and slits) which include nervous and vascular structures • congenital dehiscence (some say that they are generally found in 37% of the population) or developed dehiscence of the orbital walls, respectively of the canalis opticus which allow direct contacts between the mucoperiosteum of the sinus and the orbital structures; similar alterations of the lateral wall of the sphenoidal sinus were described in approximately 6% of the cases (1,3) • reduced thickness of the orbital-sinuses walls, eloquent example being lamina papyracea of the ethmoid • orbital periosteum mainly non-adherent allows septic collections and hematoma to pass into the orbital 1 Corresponding Author: Karin Horvath, Ofthalmology Clinic Târgu-Mureş, 26 Marton Aron street, 540082 Târgu-Mureş, Romania, e-mail: kuhorvath@gmail.com, tel +40- (0265) 26.21.22 ACTA MEDICA TRANSILVANICA March 2010; 2(1):158-160 AMT, vol II, nr. 1, 2010, pag. 158