İsa ÖZBAY, Cüneyt KUCUR, Onur ERDOĞAN, FATİH OĞHAN, Mehmet TETİKOĞLU, Hacı Murat SAĞDIK

Rinosinüzit Komplikasyonu: İnatçi Subperiosteal Apse

Amaç: Subperiostal apse; en sık görülen orbital komplikasyondur. Periorbita ile kemik duvar arasında püy birikimi ile karakterizedir. Rinosinüzit komplikasyonu olarak ortaya çıkan ve tedaviye dirençli subperiostal apse olgusunu literatür eşliğinde tartışarak sunuyoruz Olgu: On iki yaşında kız hasta üç gün önce başlayan sağ gözde şişlik ve kızarıklık şikayeti ile başvurdu. Muayenesinde proptozis, süpero-lateral bakış kısıtlılığı; nazal kaviteyi obstrükte eden ileri derecede ödem, hiperemi ve pürülan sekresyon izlendi. Medikal tedavi ile takip edilen hastanın kliniğinde düzelme olmaması aksine progresyon göstermesi üzerine endoskopik sinüs cerrahisi yapıldı. Takiplerinde rinosinüzit ve proptozisi yeteri kadar gerilemeyen hasta ikinci kez operasyona alındı. Post-op kontrollerinde, proptozisi gerilediği izlendi. Sonuç: Rinosinüzit komplikasyonu olarak ortaya çıkan subperiostal apse olgularında hastalarda görme kaybı, kavernöz sinüs trombozu, subdural abse ve menenjit gibi mortalite ile seyredebilecek durumlar meydana gelebilmektedir. Medikal tedavi ile yakın takipte bulguları düzelmeyen ya da progresyon gösteren vakalarda uygun cerrahi girişim yapılmalıdır. Tam düzelme olmayan vakalarda ''second look (ikincil bakı)'' ihtiyacı olabileceği akılda tutulmalıdır.

Rhinosinusitis Complication: Persistent Subperiosteal Abscess

Purpose: The most common orbital complication is subperiosteal abscess. It is characterized by accumulation of the pus between periorbita and bone wall. We presented a case with subperiosteal abscess which was resistant to treatment and occurred as a complication of rhinosinusitis in the light of literature Case: Twelve years old girl was admitted to outpatient clinics with right eye swelling and hyperemia beginning at 3 days ago. She had proptosis, supero-lateral overview limitation in eye; hyperemia, severe edema and purulent secretion in nasal cavity. Although she was followed up with medical therapy, her proptosis didn’t regress, even progressed, so endoscopic sinus surgery was done. Rhinosinusitis and proptosis didn’t regress during post-operative follow up, therefore second operation was done. In post-operative follow up, proptosis was resolved. Result: In patients with subperiosteal abcess as a result of rhinosinusitis complication, patients should be closely monitored. Vision loss, cavernous sinus thrombosis, subdural abscess and meningitis may occur with mortality. If it doesn’t regress or progress despite medical therapy, suitable surgery should be applied. In non-full recovery cases, second look is needed.

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