Intracranial and Orbital Complications of Sinusitis: A Case Series and Review of Literature

Complications of paranasal sinus infection most often involve the orbit and periorbita. Because intracranial extension of sinus disease is infrequently seen today, the clinician may be unfamiliar with the evaluation and management of this potentially devastating complication. Despite recent advances in treatment and diagnostic imaging, intracranial extension is often not recognized early enough to prevent delays in treatment aimed at reducing morbidity and mortality.1,2 In the reported cases, intracranial suppurative complication was detected at variable times after admission even though one of the patient presented with orbital complication. Superior sagittal sinus thrombosis is relatively a rare dural venous sinus complication than cavernous sinus thrombosis both of which were seen in one of the cases. A kaleidoscopic neurological presentation and full recovery made by all the patients at the time of discharge made these cases more interesting. Intracranial complications are most often associated with infections of the frontal, ethmoidal and sphenoidal sinuses. Maxillary sinusitis rarely extends intracranially; however, odontogenic maxillary sinusitis has shown an increased tendency for intracranial spread.3 Complicated sinusitis can lead to brain abscess, subdural empyema, meningitis, cavernous sinus thrombosis, epidural abscess and osteomyelitis, all occurring either alone or in various combinations. In this case series we have discussed the clinical presentation, which can be quite misleading, the progression of the disease and the vital role played by the radiological investigations in assessing the extent of the disease and surgical treatment.