Pain management in a child with odontogenic orbital cellulitis and severe complications
Keywords:orbital cellulitis, pain, children, analgesia
Introduction. Orbital cellulitis is a diffuse purulent inflammation of the orbital tissues followed by necrosis. Complications of orbital cellulitis include meningitis or cerebral vascular thrombosis leading to death.
Background. We present the case of a 3-year-old child with orbital cellulitis and severe complications treated at the Departmentof Anesthesiology and Intensive Care, CNE “Ivano-Frankivsk Regional Children’s Clinical Hospital of Ivano-Frankivsk Regional Council”.
Results. The child presented to the ophthalmology department with complaints of pronounced lid edema and hyperemia, right eye exophthalmos, massive purulent, foul-smelling discharge from the right eye, hyphema of the inner and outer corners of the eye, absent movements of the right eyeball, hyperthermia. Non-contrast computed tomography of the brain revealed osteomyelitis of the right maxilla, cellulitis of the right orbit, right-sided sinusitis, ethmoiditis. Under general anesthesia, there were performed deep orbitotomy, extraction of teeth 54, 55 with the extraction area drainage, puncture of the right maxillary sinus. Multimodal analgesia, detoxification therapy, empiric antimicrobial therapy, immune replacement therapy, protein replacement therapy, and syndromic treatment were chosen. On the 9th day, the child’s condition improved, and he was transferred to the ophthalmology department. On the 27th day of hospital stay, the child was discharged home in a satisfactory condition.
Conclusions. The child’s recovery was achieved due to timely hospitalization and surgery, goal-directed antibiotic therapy, application of multimodal anesthesia principles and adequate pain management, immune replacement therapy, usage of non-specific detoxification methods and adequate rehydration therapy.
McKinley SH, Yen MT, Miller AM, Yen KG. Microbiology of Pediatric Orbital Cellulitis. American Journal of Ophthalmology [Internet]. Elsevier BV; 2007 Oct;144(4):497–501. Available from: https://doi.org/10.1016/j.ajo.2007.04.049
Murphy C, Livingstone I, Foot B, Murgatroyd H, MacEwen CJ. Orbital cellulitis in Scotland: current incidence, aetiology, management and outcomes: Table 1. British Journal of Ophthalmology [Internet]. BMJ; 2014 Jun 17;98(11):1575–8. Available from: https://doi.org/10.1136/bjophthalmol-2014-305222
Rudloe TF, Harper MB, Prabhu SP, Rahbar R, VanderVeen D, Kimia AA. Acute Periorbital Infections: Who Needs Emergent Imaging? Pediatrics [Internet]. American Academy of Pediatrics (AAP); 2010 Apr 1;125(4):e719-26. Available from: https://doi.org/10.1542/peds.2009-1709
Singh M, Negi A, Zadeng Z, Verma R, Gupta P. Long-Term Ophthalmic Outcomes in Pediatric Orbital Cellulitis: A Prospective, Multidisciplinary Study From a Tertiary-Care Referral Institute. Journal of Pediatric Ophthalmology & Strabismus [Internet]. SLACK, Inc.; 2019 Sep;56(5):333–9. Available from: https://doi.org/10.3928/01913913-20190807-01
Stead TG, Retana A, Houck J, Sleigh BC, Ganti L. Preseptal and Postseptal Orbital Cellulitis of Odontogenic Origin. Cureus [Internet]. Cureus, Inc.; 2019 Jul 6; Available from: https://doi.org/10.7759/cureus.5087
Wald ER. Periorbital and Orbital Infections. Principles and Practice of Pediatric Infectious Disease [Internet]. Elsevier; 2008;511–6. Available from: https://doi.org/10.1016/b978-0-7020-3468-8.50095-x
Wong SJ, Levi J. Management of pediatric orbital cellulitis: A systematic review. International Journal of Pediatric Otorhinolaryngology [Internet]. Elsevier BV; 2018 Jul;110:123–9. Available from: https://doi.org/10.1016/j.ijporl.2018.05.006
Yen KG, Chilakapati MC, Coats DK, Miller AM, Paysse EA, Steinkuller PG. OCULAR INFECTIOUS DISEASES. Feigin and Cherry’s Textbook of Pediatric Infectious Diseases [Internet]. Elsevier; 2009;811–35. Available from: https://doi.org/10.1016/b978-1-4160-4044-6.50073-x
Vittinghoff M, Lönnqvist P-A, Mossetti V, Heschl S, Simic D, Colovic V, et al. Postoperative pain management in children: Guidance from the pain committee of the European Society for Paediatric Anaesthesiology (ESPA Pain Management Ladder Initiative). Pediatric Anesthesia [Internet]. Wiley; 2018 Apr 10;28(6):493–506. Available from: https://doi.org/10.1111/pan.13373
Dmitriev DV, Zaletsky BV, Dmitrieva KYu, Semenenko AI, Moravskaya OA. Multimodal analgesia is a method of eliminating intra-abdominal hypertension after surgery in children [Mulʹtymodalʹna analheziya – metod usunennya vnutrishnʹocherevnoyi hipertenziyi pislya operatsiyi u ditey]. Clinical Surgery. 2017;8:59-61. [In Ukrainian]
Dmitriev DV, Zaletsky BV, Dmitrieva KYu. Rationale for the use of multimodal analgesia for postoperative anesthesia in children [Obhruntuvannya zastosuvannya skhem mulʹtymodalʹnoyi analheziyi dlya pislyaoperatsiynoho znebolennya u ditey]. Clinical Surgery. 2017;11:54-6. [In Ukrainian]
Babina YuM, Dmitriev DV, Nazarchuk OA. Antimicrobial activity of local analgesics against pathogens of wound infection associated with the provision of medical care [Antymikrobna aktyvnistʹ lokalʹnykh analʹhetykiv proty zbudnykiv ranovoyi infektsiyi, povʺyazanoyi z nadannyam medychnoyi dopomohy]. Medicine of emergencies. 2019;2:162. [In Ukrainian]
Dmitriev DV, Semenenko AI, Glazov EO, Kalinchuk OO. Patient-controlled analgesia in pediatric surgery [Patsiyent-kontrolʹovana analheziya v dytyachiy khirurhiyi]. Medicine of emergencies. 2019;2:185-6. [In Ukrainian]
How to Cite
This work is licensed under a Creative Commons Attribution 4.0 International License.
This work is licensed under a Creative Commons Attribution 4.0 International License