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.

The data that support the findings of this study are available from the corresponding author upon reasonable request.

AI Disclosure
The authors declare that artificial intelligence (AI) tools were not used, or were used solely for language editing, and had no role in data analysis, interpretation, or the formulation of conclusions. All scientific content, data interpretation, and conclusions are the sole responsibility of the authors. The authors further confirm that AI tools were not used to generate, fabricate, or ‘hallucinate’ references, and that all references have been carefully verified for accuracy.

O.T., M.K., S.B.: Ccontributed to the conception of the study; O.T., M.K., I.Y.: Contributed to the study design, provided the study materials; O.T., O.Y.: Supervised and controlled the study; I.Y., S.B.: Were responsible for data collection; O.T., A.D., M.K., I.Y.: Contributed to the analysis and interpretation of the data; S.B., I.Y.: Performed the literature review; O.T., I.Y.: Drafted the manuscript; O.T., M.K., O.Y.: Critically reviewed and revised the manuscript; O.T.: Was responsible for the references and funding-related processes. All authors read and approved the final version of the manuscript.

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

The authors received no financial support for the research and/or authorship of this article.