A 4-YEAR-OLD Indian boy was referred to our institution for the evaluation of progressive left-sided facial and periorbital edema. He was seen by his pediatrician week before presentation for fever, cough, nasal congestion, and headache. Oral antibiotic therapy was initiated, but the fever persisted, and the patient developed new-onset periorbital and facial edema. The findings of the rest of his medical and surgical history were unremarkable.
Physical examination revealed left periorbital erythema, edema, and an inability to open the left eye. Significant erythema and edema of the left malar region, with tenderness, were noted. Nasal examination via anterior rhinoscopy was significant for thick purulent secretions filling both nasal cavities. Rigid endoscopy using a 0° telescope demonstrated a mass protruding into the left nasal cavity along the lateral wall. The examination of the head and neck, including the oral cavity, revealed no other abnormalities. An ophthalmologic consultation was obtained. The patient was noted to have mild proptosis of the left eye. The results of the rest of the eye examination were unremarkable.
Batti JS, Zahtz G, O'Reilly B. Quiz Case 4. Arch Otolaryngol Head Neck Surg. 2000;126(5):676-680. doi: