Orbital cellulitis secondary to sinusitis in upstate New York: current incidence, seasonality, severity, management and outcomes

• Published in: Orbit (Amsterdam) Vol. 41; no. 2; pp. 199 - 203
• Main Authors: Lee, Kathryn, Lee, Daniel D., Stevanovic, Milanka, Feustal, Paul, Brand, Alexander, Pauze, Denis, Wladis, Edward J.
• Format: Journal Article
• Language: English
• Published: England Taylor & Francis 04-03-2022
• Subjects: Cellulitis - complications; Cellulitis - microbiology; Functional endoscopic sinus surgery; Humans; Incidence; New York - epidemiology; orbital cellulitis; Orbital Cellulitis - diagnostic imaging; Orbital Cellulitis - epidemiology; Orbital Cellulitis - etiology; Orbital Diseases - diagnostic imaging; Orbital Diseases - epidemiology; Orbital Diseases - etiology; orbitotomy; Retrospective Studies; sinusitis; Sinusitis - diagnostic imaging; Sinusitis - epidemiology; Sinusitis - therapy; sinusitis-related orbital cellulitis; New York; orbital cellulitis; sinusitis; sinusitis-related orbital cellulitis; orbitotomy; Functional endoscopic sinus surgery
• DOI: 10.1080/01676830.2020.1862246
• EISSN: 1744-5108
• ISSN: 0167-6830

While sinusitis carries a seasonal variation, the temporal features of sinusitis-related orbital cellulitis (SRC) are unclear. This study analyzes the incidence, seasonality, management, and outcomes of SRC in northeastern New York.
A retrospective review of 79 patients was performed from January 2008 - December 2018. Cases of orbital cellulitis without comitant sinusitis were excluded. Demographic, radiographic, clinical features, month at presentation, interventions (surgical and nonsurgical), microbiology, and hospitalization duration were recorded. Fisher-exact test, Mann-Whitney test, and Kruskal Wallis test statistical analyses were performed in consultation with our institution's statistician via a dedicated software package (vassarstats.net).
79 patients were admitted for SRC. 25 patients were treated with antibiotics only, 31 underwent orbitotomy exclusively and 23 received combined orbitotomy and functional endoscopic sinus surgery (FESS). Of the 31 patients who underwent orbitotomy only, 8 (26%) returned to the operating room. In contrast, of those who underwent concomitant orbitotomy and FESS, only one patient (4.3%) required re-operation (fisher exact test, p = .021). The median length of stay for the antibiotic-only group (4 days), orbitotomy-only group (6 days), and combined surgery group (5 days) were statistically different (Kruskal Wallis, p = .004, Figure 3). Interestingly, there was no significant relationship of incidence or severity of SRC related to seasonality (fisher-exact test, p = .76).
Our findings suggest that cases requiring surgical management for SRC should undergo coinitial orbitotomy with FESS to reduce re-operation rates. Additionally, SRC incidence and severity did not correlate with season.