[Differential diagnosis of acute maxillary ethmoiditis complicated by orbital abscess with dacryocystitis and phlegmon of the lacrimal sac in children].

Introduction: The differential diagnosis of orbital complications of rhinosinusitis with diseases of the lacrimal sac in childhood remains unresolved both due to the similarity of the symptoms of the diseases and due to certain diagnostic difficulties requiring computed tomography.

Objective: To develop an algorithm for routing a patient to the emergency department of a multidisciplinary emergency hospital based on clinical and diagnostic distinctive features of sinusitis with orbital complications and diseases of the lacrimal sac with reactive edema of the eyelids.

Materials And Methods: A retrospective cohort analysis of children's medical histories, who were treated in the otorhinolaryngological and ophthalmological departments of the Morozovskaya Children's City Clinical Hospital during 2022 was performed for orbital complications of rhinosinusitis or dacryocystitis with reactive edema of the eyelids. The patients were divided into two groups, according to the main diagnosis: group I included children with intraorbital complications of sinusitis, and group II included patients with diseases of the lacrimal sac.

Results: The study included 275 patients (170 children with intraorbital complications of sinusitis and 105 patients with diseases of the lacrimal sac). The median age of patients was 10 years (Q-Q 7-13 years) for patients in group I and 8 months (Q-Q 6-11 months) for group II. In children with intraorbital complications of sinusitis, pain in the sinus projection area (96.4%), nasal congestion (94.1%) and discharge in the nasal cavity (90.6%) were most often noted. The highest prognostic significance for this disease was pain in the sinus projection (positive prognostic value 92.1%, negative prognostic value 93.8%) and nasal congestion (positive prognostic value 94.1%, negative prognostic value 90.5%). CT markers with a high level of specificity for intraorbital complications of sinusitis are: thickening of the ocular muscles, thickening or destruction of the medial orbital wall, fat infiltration or orbital abscess. For dacryocystitis, computed tomography (CT) markers are: infiltrative changes in the lacrimal sac, phlegmon and abscess of the lacrimal sac.

Conclusion: The greatest diagnostic value for orbital complications of sinusitis is pain in the sinus projection, as well as the presence of swelling and nasal discharge. CT scan of the paranasal sinuses has greater specificity in determining infiltrative changes in the lacrimal sac, intraorbital tissue and musculoskeletal structures of the orbit and is indicated for all patients with suspected orbital complication of rhinosinusitis.