The Safety and Feasibility of Extended Endonasal Approaches to Orbital Cellulitis in Infants and Toddlers

Objective: Surgical management of orbital cellulitis in infants and toddlers has traditionally been limited to external approaches. The safety and feasibility of extended endonasal approaches has not been established. We report a review of modern management of orbital cellulitis in infants and toddlers as well as a series of children 2 years old and younger managed both medically and surgically at our institution. We aim to establish the extended endonasal approach as an option in the surgical treatment of orbital cellulitis.

Methods: The medical charts of all children age 2 years and younger hospitalized from January 2007 to September 2012 with an ICD-9 diagnosis of orbital cellulitis were reviewed. Seven cases were identified.

Results: Seven children age 2 years and younger were managed for orbital cellulitis. Four were managed with intravenous antibiotics, and three were treated surgically. Surgical techniques included two extended endonasal approaches to orbital decompression and one external anterior orbitotomy. There were no complications in any of the patients managed medically or surgically. All patients improved with the modality of treatment chosen.

Conclusions: We report a series of infants and toddlers with orbital cellulitis, two of which were managed with extended endonasal approaches. It is feasible to manage infants and toddlers as young as 9 months old who require surgery for orbital cellulitis with extended endonasal techniques. Although there were no complications in this study, a larger cohort of patients managed through extended endonasal approaches would be required to establish its safety in this population.