Intra and Extracranial Suppurative Complications of Sinusitis, Management with Limited Resources-� A Report of Two Cases with a Review of the Literature

Unusual clinical presentations of intra cranial suppurative complication of sinusitis make it difficult to be to be diagnosed and make it a challenging task. Even in present time this pathology is known to produce significant morbidity and mortality. A short review of the literature on ICS has been done with our experience of two cases who had varying clinical presentations and in spite of their management with limited available resources, both the cases recovered fully with limited morbidity. The first case, a 12 years old boy had no clinical evidence of sinusitis but had high fever, signs of increased intra cranial pressure, orbital cellulites and abscesses on left upper eye lid and on same side of forehead. The CT scan revealed Fronto- Maxillary sinusitis, periorbital cellulites, lid and forehead abscesses along with oedema in brain for which an external Fronto-Ethmoido-Maxillary antrostomy [Lynch-Howarth operation] was done along with drainage of extra cranial abscesses in the eyelid and forehead.   The second case, a 21 years old female, known to have nasal allergies had a high fever, right eye congested and proptosed and had signs of increased ICP. The CT and MRI revealed that she had a subdural empyma, Frontal sinusitis and a periorbital Cellulites. The subdural empyma was drained by a neuro- surgeon and the sinus abscesses were drained [Lynch Howarth operation] by an Otolaryngologist, at the same time. Both the patients recovered in 4 to 6 week. In conclusion, the diagnosis of ICS requires a high index of suspicion and early radiographic imaging [CT/MRI] of the head and paranasal sinuses. An aggressive medical therapy is indicated and it may require drainage of the sinus abscess and the intra cranial abscess, at the same time.