Abstract

Objectives: This study aims to evaluate clinical and radiological factors, particularly age, Chandler stage, and sinonasal anatomic variations, associated with surgical intervention in pediatric orbital complications secondary to acute rhinosinusitis.
Patients and Methods: This retrospective cohort study included 100 pediatric patients hospitalized between May 2020 and December 2025. Clinical, ophthalmological, and paranasal sinus computed tomography findings were reviewed. Chandler and Keros classifications, septal deviation, Agger nasi, Haller and Onodi cells, concha bullosa, adenoid hypertrophy, and frontal sinus agenesis were assessed. Factors associated with surgical intervention were analyzed using logistic regression analyses.
Results: The cohort comprised 100 pediatric patients (58 males, 42 females; median age: 7 years; interquartile range [IQR], 4 to 11 years; range, 0 to 17 years) hospitalized for acute rhinosinusitis with orbital complications, with a median hospital stay of eight days (IQR: 4 to 12.25). Surgery was required in 18% of cases, whereas 82% were managed medically. Chandler stage correlated with hospitalization duration (Spearman’s rho = 0.583, p < 0.001). The surgery rate was 84.2% in Chandler Stage III or higher versus 2.5% in lower stages. In multivariate analysis, Chandler stage showed the strongest association with surgical intervention (adjusted odds ratio [aOR] = 205.0, 95% confidence interval [CI]: 30.99-1355.73, p < 0.001). Surgical probability also increased with age (aOR = 1.26 per year, 95% CI: 1.11-1.49, p < 0.001). Most anatomical variations were not significantly associated with surgery, although no patient with frontal sinus agenesis required surgical intervention.
Conclusion: Chandler stage and age were the factors most strongly associated with surgical intervention in pediatric orbital complications. These findings should be interpreted in the context of disease-severity-based clinical decision-making. Frontal sinus agenesis was associated with the absence of surgical intervention in this cohort; however, this finding should be interpreted as hypothesis-generating. Treatment planning should primarily rely on clinical staging and age rather than incidental anatomic variations.

Citation: Tuysuz O, Yesil I, Dablan A, Bayrak S, Keskin M, Yigit O. Predictors of surgical intervention in pediatric orbital complications of acute rhinosinusitis. Praxis Otorhinolaryngol 2026;14(3):165-171. https://doi.org/10.5606/kbbu.2026.30.