Background:Chronic rhinosinusitis with nasal polyps (CRSwNP) in children is a clinically significant inflammatory disorder characterized by persistent symptoms and complex underlying mechanisms. This study used multi-omics approaches to investigate potential microbial and metabolic associations in pediatric CRSwNP. Methods:Nasal secretions from 20 children with CRSwNP and 19 healthy controls were analyzed using metagenomics, untargeted metabolomics, and proteomics. Results:CRSwNP patients showed higher microbial diversity and altered microbial communities, with increased Streptococcus abundance. Metabolomic sequencing revealed that 13'-Hydroxy-alpha-tocopherol was significantly upregulated in the CRSwNP group and exhibited a positive correlation with the abundance of Streptococcus. Proteomic sequencing revealed that proteins involved in glutathione metabolism were significantly downregulated in the CRSwNP group, with GCLM and GGCT showing a significant negative correlation with 13'-Hydroxy-alpha-tocopherol. Conclusion:These associative findings suggest potential links among Streptococcus, 13'-Hydroxy-α-tocopherol, and glutathione metabolism, indicating that oxidative stress-related imbalance may contribute to pediatric CRSwNP. These results provide preliminary evidence that 13'-Hydroxy-α-tocopherol may serve as a potential biomarker for pediatric CRSwNP.

Pediatric nasal skull base tumors are rare and difficult to diagnose early due to their deep anatomical location and children's limited ability to describe symptoms. When the tumors progress to advanced stages, nonspecific symptoms such as nasal congestion, nosebleeds, and facial swelling are easily confused with sinusitis or trauma, complicating diagnosis and treatment. Moreover, the special tumor anatomical location and the narrow nasal cavity in children increase the risk of tumor involvement with the surrounding structures. Given children's longer life expectancy and higher postoperative quality of life demands, personalized treatment and comprehensive medical management are essential. Advances in artificial intelligence (AI) and digital medicine have played an important role in early diagnosis, multidisciplinary treatment, prognosis assessment, and follow-up. However, despite the widespread use of emerging AI-related technologies, their application in pediatric nasal skull base tumors remains limited. This review discusses the potential applications of AI and digital medicine in the whole-process medical management of these tumors, including diagnosis, treatment, prognosis, and follow-up, along with current challenges.

Median palatine cysts (MPCs) and nasopalatine duct cysts (NPDCs) are rare non-odontogenic cystic lesions in the pediatric population. Due to their low incidence and often asymptomatic nature in children, these cysts are frequently overlooked or misdiagnosed. To the best of our knowledge, few comparative pediatric cases have been reported. The novelty lies in the detailed histopathological differentiation and the analysis of their impact on maxillofacial development, providing a crucial clinical reference for early intervention. In this report, two pediatric patients presented with similar clinical manifestations and obvious dental malalignment. Initial imaging suggested NPDCs in both cases. Both patients underwent complete cyst removal via endoscopic nasal surgery. Postoperative histopathological examination confirmed the distinct diagnoses: one as an MPC and the other as an NPDC. The primary histopathological differentiator was the composition of the fibrous cyst wall; the NPDC contained specialized structures (blood vessels, nerves, and mucous glands), which were absent in the MPC. At the two-year follow-up, both patients showed favorable maxillofacial development and no signs of recurrence. These cases illustrate that while MPCs and NPDCs may share clinical similarities, they possess distinct histopathological characteristics. The endoscopic approach appears to be a feasible surgical option in these cases. Early and accurate differential diagnosis can aid in surgical planning and may help mitigate potential impacts on pediatric maxillofacial development, offering useful insights for otolaryngologists and pediatric dentists.

Artemisia annua sublingual immunotherapy in children with seasonal allergic rhinitis To the Editor,Artemisia pollen is the main aeroallergen of seasonal allergic rhinitis (SAR) in summer and autumn.1,2Artemisia annua Allergens Sublingual Immunotherapy (SLIT) Drops (Zhejiang Wolwo Bio-Pharmaceutical Co., Ltd., Zhejiang, China, National Drug Approval No.: S20210001) is the only standardized SLIT preparation approved in China for treatingArtemisia-induced allergic rhinitis with or without conjunctivitis (AC).3 In this study, we aimed to evaluate the safety and efficacy of A. annua- SLIT in children with SARs.Pediatric patients with at least a two-year clinical history ofArtemisia pollen-induced SAR with or without AC from Inner Mongolia were included in this randomized, double-blind, placebo-controlled, single-center clinical trial and randomized to receive A. annua -SLIT or placebo at a 2:1 ratio for approximately 28 weeks. The combined score of medication and rhinitis symptoms (CSMS; primary endpoint) and combined score of medication and rhinoconjunctivitis symptoms (CSMRS; secondary endpoint) were recorded to evaluate efficacy; adverse events (AEs) were reported to assess safety.Fifty-seven eligible patients aged 4–18 years were randomized into the SLIT (n=38) and placebo (n=19) groups (Figure 1). Finally, 54 patients (SLIT group: n=36; placebo group: n=18) completed the study with 3 patients withdrew by themselves. No significant differences were observed between the groups in terms of sex, age, atopic status, comorbidity of other allergic diseases, and CSMS and CSMRS scores in the previous pollen season (P >0.05, Table S1).The 2019 pollen season in Inner Mongolia was from 20th July to 7th September (50 days; Figure 2A). The temporal variation of daily CSMRS in both groups showed a similar trend of positive correlation with pollen concentration throughout the pollen season (SLIT group: r=0.66, 95% CI: 0.53–0.76; placebo group: r=0.68, 95% CI: 0.56–0.77). The SLIT group showed significant improvements in CSMS (1.55±0.81 vs. 1.97±0.73) and CSMRS (1.46±0.75 vs. 1.88±0.75) compared with the placebo group (P <0.05, Figure 2B–C). Fifty-three (98.1%) patients experienced AEs [35, SLIT group; 18, placebo group] (Table S2). All AEs were mild or moderate and resolved without any action or by adjusting the dose of the study drug. There were no significant differences in the incidence and severity of AEs between the groups (P >0.05). Epinephrine use was not reported, and no patients withdrew from the trial because of AEs. Furthermore, 94.4% and 100% of patients in the SLIT and placebo groups, respectively, experienced treatment-related AEs (TRAEs), which frequently occurred in the nose, eyes, throat, and tongue in both groups (P >0.05, Figure 2D). The common TRAEs in children with SLIT are shown in Figure 2E. Most TRAEs in the SLIT group were mild, similar to those in the placebo group.To our knowledge, this is the first study to report the efficacy and safety of A. annua -SLIT in a Chinese pediatric population. Our results showed a consistent trend of clinical efficacy improvements withA. annua -SLIT in children similar to those in adults.4 Recently, a cumulative AE incidence of 93.0% was reported with ragweed SLIT in children and adolescents, with no serious AEs.5 The incidence of AEs in our study were comparable to those in the previous study. Lou et al. found that the most common TRAEs in adults with A. annua -SLIT were mild or moderate.4,6 Our results showed a safety profile similar to that in adults. No new safety signals emerged, and no throat irritation was observed in adults.In conclusion, 28-week A. annua -SLIT treatment was effective and safe for children with SAR, with no major safety concerns. Investigating the benefits of A. annua -SLIT in children will not only expand its application for treatment but also provide the basis for intervention in the early phase of SAR.

Background:Proboscis lateralis (PL) is a rare congenital malformation of the craniofacial structure. On the basis of 34 reported cases, Boo-Chai developed the first classification system in 1985 based on commonly associated anomalies of the eyes, palate, and lips. Sinonasal deformity is the most prevalent systemic abnormality associated with PL, accounting for 87.9%, and concomitant ocular anomalies account for 44-70%.Case Description:We report a case of PL in a 20-month-old female patient with a mass in the left medial canthal area, and ipsilateral symptomatic epiphora. The removal of the proboscis at 4 months without the reconstruction of the nasolacrimal duct resulted in secondary sequelae that lasted 16 months. A second operation by a multidisciplinary team released the pressure on the lacrimal sac and reconstructed the lacrimal system. External dacryocystorhinostomy (DCR) is performed through the original external incision aided by nasal endoscopic examination. The bony passage between the nasal cavity and the lacrimal sac was reconstructed, and nasal endoscopy revealed a wide opening in the nasal cavity of at least 6 mm. Follow ups ensured a patent nasal airway, without complications.Conclusions:It is instructive to learn from this case that treatment plans for PL should consider associated ocular anomalies and lacrimal drainage reconstruction, following a comprehensive and multidisciplinary approach.

In this article, we report a 10-year-old boy with acute bacteremia and left eye blindness. Culture from abscess drainage was positive for Streptococcus constellatus . Infection caused by S. constellatus is rare among children, and to our knowledge, this is the first report of this pathogen causing blindness. The rapidness of progression in this case is alarming. We also summarize other cases of S. constellatus infection.

Objective: To explore the clinical characteristics, pathological features, and diagnosis and treatment strategies of nasal chondromesenchymal hamartoma (NCMH) in infants and young children. Methods: A retrospective analysis was conducted on seven cases of NCMH infants and young children admitted to Beijing Children's Hospital, Capital Medical University from April 2015 to January 2022. The cohort included 5 males and 2 females, aged from 6 days to 2 years and 3 months. General information, clinical symptoms, imaging findings, treatment plans, postoperative complications, recurrence and follow-up time were collected, summarized and analyzed. Additionally, immunohistochemical characteristics of the lesion were examined. Results: The clinical symptoms of 7 children included nasal congestion, runny nose, open mouth breathing, snoring during sleep, difficulty feeding, and strabismus. All patients underwent electronic nasopharyngoscopy examination, with 5 cases of tumors located in the right nasal cavity and 2 cases in the left nasal cavity. No case of bilateral nasal cavity disease was found. All 7 patients underwent complete imaging examinations, with 5 patients underwent MRI and CT examinations, 1 patient underwent CT examination only, and 1 patient underwent MRI examination only. The CT results showed that all tumors were broad-based, with uneven density, multiple calcifications and bone remodeling, and some exhibited multiple cystic components. The MRI results showed that the tumor showed low signal on T1 weighted imaging and high or slightly high signal on T2 weighted imaging. All patients were diagnosed through histopathological examination and immunohistochemistry, including 7 cases of Ki-67 and SMA (+), 5 cases of S-100 and Vimentin (+), and all EMA and GFAP were negative. All patients underwent endoscopic resection surgery through the nasal approach, with 3 cases using navigation technology. Five cases of tumors were completely removed, and two cases of tumors were mostly removed. No nasal packing was performed after surgery, and no postoperative nasal, ocular, or intracranial complication occurred in all patients. Follow up assessments conducted 6 to 84 months post-surgery revealed no instances of tumor recurrence in any of the patients. Conclusions: The clinical symptoms of children with NCHM mainly depend on the size and location of the tumor. Nasal endoscopic surgery is the main treatment method. In cases where critical structures like the skull base or orbit are implicated, staged surgical interventions may be warranted. Long-term follow-up is strongly advised to monitor for any potential recurrence or complications.

Background: Chronic Rhinosinusitis is a common disease in children. The main function of CFTR is to maintain the thickness of the mucous layer on the surface of the nasal mucosa. CFTR disease-causing variant can cause CFTR protein dysfunction and induce or aggravate chronic infection. However, the carrying status of the CFTR variants in the Chinese population is not clear. Objective: To study the frequency and variants of CFTR in Chinese children with CRS and to analyze the CFTR variants and the clinical characteristics and susceptibility to CRS. Methods: Whole Exome Sequencing was performed to analyze the CFTR genes in a total of 106 CRS children from the Chinese mainland area. The CFTR variants, frequency and clinical data were summarized and analyzed. Results: A total of 31 CFTR variants were detected, of which the carrying rate of 7 sites was significantly higher than that of the population database. 88 patients carried more than 2 variants. 37 people carried variants (MAF < 0.05), of which 91.89% had a history of recurrent upper respiratory infections, 16 had nasal polyps, 5 had bronchiectasis, and 1 was diagnosed with CF-related disorders. Conclusion: The carrying rate of CFTR variants in Chinese CRS children increased, and the highest rates of variants (MAF < 0.05) are p.I556V, p. E217G, c.1210-12[T]. Carrying multiple CFTR variants, especially p.E217G, p.I807 M, p.V920L and c.1210-12[T] may lead to increased susceptibility to CRS. There are CF-related disorders in patients with CRS.

To explore the association between the severity of sleep-disordered breathing, different types of respiratory events, peripheral oxygen saturation (SpO(2)), age and sleep stage on cerebral oxygen saturation (rSO(2)) in children. We enrolled children aged 4-14 years who were treated for snoring or mouth breathing at the Sleep Center of Beijing Children's Hospital, from February 2022 to July 2022. All children completed polysomnography, and SpO(2), rSO(2), and heart rate (HR) were recorded synchronously. A total of 70 children were included, including 16 (22.9%) with primary snoring, 38 (54.3%) with mild obstructive sleep apnea (OSA), and 16 (22.9%) with moderate-to-severe OSA. There were no significant differences in the mean rSO(2) or minimum rSO(2) among the primary snoring, mild OSA, and moderate-to-severe OSA groups (all p > 0.05). A total of 1119 respiratory events were included in the analysis. Regardless of the type of respiratory event, rSO(2) and HR changes occur prior to fluctuations in SpO(2). A mixed-effects model showed that Delta rSO(2) was positively correlated with Delta SpO(2), duration of respiratory event, mixed and obstructive apnea, central apnea, while negatively correlated with age and rapid eye movement (REM) sleep stage (all p < 0.05). Larger rSO(2) fluctuations were impacted by a greater Delta SpO(2), longer duration of respiratory events, younger age, apnea-related respiratory events and non-REM sleep stage. Thus, sleep disordered breathing in younger children warrants more attention. More research is needed to determine whether REM sleep has special protective effects on rSO(2).

BACKGROUND:Ionocytes are rare cells in airway epithelium characterized by a high expression of CFTR.OBJECTIVES:To investigate the morphology and distribution of ionocytes and the function of CFTR in the nasal mucosal epithelium of children.METHODS:The exfoliated cells of nasal mucosa from 101 children were detected using flow cytometry to analyze the number of ionocytes and CFTR and the difference of CFTR function. Nasal mucosa and polyps were collected from 10 children with CRSwNP. The RNAscope of FOXI1 and CFTR was detected in pathological paraffin sections. The expression and distribution of ionocytes and CFTR in nasal mucosa and polyp epithelium were observed.RESULTS:In CRS patients, the number of ionocytes in the nasal epithelium was lower and the number of ionocytes that did not express CFTR was higher, and the function of CFTR was also decreased. The expression of CFTR in the nasal mucosa of CRS showed the characteristics of local dense distribution and increased as the inflammation expanded. The ionocytes were "tadpole-shaped" in the epithelium and gathered in the area of high CFTR expression, the intracellular CFTR was expanded in clusters. Ionocytes that did not express CFTR was more common in the nasal polyps.CONCLUSIONS:The number of ionocytes and the function of CFTR in nasal mucosa of CRS patients decreased. With the expansion of inflammation, CFTR and ionocytes showed more obvious dense distribution. Some ionocytes lost the expression of CFTR and did not show the "tadpole" shape, which may be related to the occurrence of polyps.

目的 探讨获得性囊性纤维化跨膜传导调节因子(cystic fibrosis transmembrane conductance regulator,CFTR)功能障碍及炎性细胞因子在儿童鼻-鼻窦炎发展中的作用.方法 纳入2021年1—12月在首都医科大学附属北京儿童医院耳鼻咽喉头颈外科因急慢性鼻-鼻窦炎行鼻内镜手术治疗31例患儿,其中慢性鼻窦炎(chronic rhinosinusitis,CRS)患儿17例(CRS组),急性细菌性鼻窦炎(acute bacterial rhinosinusitis,ABRS)患儿14例(ABRS组).收集所有患儿的全血、鼻黏膜及鼻息肉样本,应用全外显子二代测序技术检测全血样本中CFTR基因的表达情况,qRT-PCR检测息肉和黏膜组织中CFTR mRNA的表达水平,微量样本多重蛋白定量技术(cytometric bead array,CBA)检测息肉和黏膜组织中炎性细胞因子的表达水平.结果 根据CFTR基因检测结果,所有入组患儿均排除囊性纤维化.ABRS组鼻黏膜组织CFTR mRNA的表达水平明显低于CRS组,而CRS组鼻息肉组织CFTR mRNA的表达水平明显低于鼻黏膜组织.ABRS组鼻黏膜组织γ干扰素(interferon-γ,IFN-γ)、白细胞介素-4(interleukin-4,IL-4)、IL-13、IL-6、IL-8的表达水平明显高于CRS组(P<0.05),而CRS组鼻息肉组织IL-6、IL-8、单核细胞趋化因子-1(monocyte chemoattractant protein-1,MCP-1)的表达水平明显高于鼻黏膜组织(P<0.01).结论 获得性CFTR功能障碍及与中性粒细胞趋化相关的炎性因子在ABRS中的作用更为明显,在CRS息肉的发生发展中也可能起到一定作用.

Objective: To review the clinical characteristics, to illustrate diagnosis and management experience of orbital and cranial complications of pediatric acute rhinosinusitis. Methods: The clinical data of 24 children with orbital and cranial complications of acute rhinosinusitis who received endoscopic sinus surgery combined with drug treatment in Beijing Children's Hospital from January 2017 to December 2021 were retrospectively reviewed. There were 19 boys and 5 girls. The age varied from 13 to 159 months, with a median 47.5 months. The following diagnoses were obtained: 12 isolated subperiosteal orbital abscess, 2 associated with preseptal abscess, 2 associated with intraorbital abscess, 7 associated with optic neuritis, and 1 associated with septic cavernous sinus thrombosis. Clinical characteristics, organism isolated and outcomes were analyzed through descriptive methods. Results: All 24 patients presented with fever; 9 presented with nasal congestion and purulent discharge. The clinical manifestations of orbital infection included orbital edema, pain, proptosis and displacement of globe in all patients, while visual impairment was recognized in 7 children. Purulent drainage was cultured in 17 patients, among which 12 were positive. All patients underwent nasal endoscopic surgical interventions uneventfully, excluding one patient who required a second surgical procedure. Follow-up period ranged from 5 to 64 months. All patients resolved fully, with the exception of 2 children who got permanent blindness with visual loss preoperative. There was no recurrence or death. Conclusions: Orbital and cranial complications of pediatric acute rhinosinusitis could be severe with an occult onset. For patients with vison impairment, any signs of intracranial complications and a lack of response to conservative management, an urgent endoscopic intervention is needed.

H 1-antihistamines are widely used in the treatment of various allergic diseases, but there are still many challenges in the safe and rational use of H 1-antihistamines in pediatrics, and there is a lack of guidance on the prescription review of H 1-antihistamines for children.In this paper, suggestions are put forward from the indications, dosage, route of administration, pathophysiological characteristics of children with individual difference and drug interactions, so as to provide reference for clinicians and pharmacists.

目的 探讨开放性鼻整形切口在治疗儿童先天性鼻中线囊肿及瘘管的手术适应证及预后.方法 回顾分析4例先天性鼻中线囊肿及瘘管的儿童[男3例,女1例,2～6岁(平均4岁)]的临床资料、影像学资料、治疗效果及预后情况,所有患儿均在接受全身麻醉下开放性鼻整形切口入路切除病灶,术后规律随访,随访参数包括病灶复发情况、切口瘢痕情况、鼻尖形态.结果 4例诊断为先天性鼻中线囊肿及瘘管中,瘘口位置均位于鼻梁中下段及鼻尖,感染灶或囊肿位于鼻根部或一侧内眦水平,瘘管走行路径＞1 cm.全部患儿术前均行鼻窦CT及MRI检查,术后规律随访19～24个月,4例患者术中均未出现并发症、术后无复发、鼻部切口瘢痕恢复好、鼻尖形态均正常.结论 开放性鼻整形切口入路用于儿童先天性鼻中线囊肿及瘘管切除的适应证为瘘口位于鼻尖至鼻部中下段,未与颅内沟通者,瘘管走行路径＞1 cm,可在充分暴露病变范围的同时兼顾美容外观,效果理想,短期随访未观察到鼻部发育异常.

Abstract Objective: To explore the role of acquired CFTR dysfunction and inflammatory chemokines in the development of rhinosinusitis in children. Design and setting Twenty-five children who underwent endoscopic sinus surgery for acute and chronic rhinosinusitis in the Department of Otolaryngology Head and Neck Surgery at our hospital from January 2021 to December 2021 were included. Whole blood, mucosa and polyp tissues of all children were collected for study. Main outcome measures： The CFTR gene was detected by using Full-length second-generation sequencing. The expression of CFTR mRNA was measured by qRT-PCR, and the expression of inflammatory chemokines was measured by CBA. Results： There were 17 cases in the CRS group and 8 cases in the ABRS group. The expression of CFTR mRNA in the mucosa of the ABRS group was lower than that of the CRS group, and the expression of IL-6 and IL-8 in the mucosa of the ABRS group was significantly higher than that of the CRS group. IL-6, IL-8 and MCP-1 were upregulated in polyps. Conclusion: The dysfunction of acquired CFTR and the role of neutrophil chemotactic factor are more obvious in ABRS, and may play a role in the occurrence and development of CRS polyps.

To examine the difference in the topological properties of brain functional network between the children with obstructive sleep apnea (OSA) and healthy controls, and to explore the relationships between these properties and cognitive scores of OSA children. Twenty-four OSA children (6.5 ± 2.8 years, 15 males) and 26 healthy controls (8.0 ± 2.9 years, 11 males) underwent resting-state fMRI (rs-fMRI), based on which brain functional networks were constructed. We compared the global and regional topological properties of the network between OSA children and healthy controls. Partial correlation analysis was performed between topological properties and cognitive scores across OSA children. When comparing the OSA children with the healthy controls, lower full-scale intelligent quotient (FIQ) and verbal intelligent quotient (VIQ) were observed. Additionally, nodal degree centrality decreased in the bilateral anterior cingulate and paracingulate gyrus, but increased in the right middle frontal gyrus, the left fusiform gyrus, and the left supramarginal gyrus. Nodal efficiency decreased in the right precentral gyrus, and the bilateral anterior cingulate and paracingulate gyrus, but increased in the left fusiform gyrus. Nodal betweenness centrality increased in the dorsolateral part of the right superior frontal gyrus, the left fusiform gyrus, and the left supramarginal gyrus. Further, the nodal degree centrality in the left supramarginal gyrus was positively correlated with FIQ. In contrast, none of global topological properties showed difference between those two groups. The outcomes of OSA may impaired the regional topological properties of the brain functional network of OSA children, which may be potential neural mechanism underlying the cognitive declines of these patients.

Objective We aimed to investigate the difference between the bacterial profiles of the nasal cavities and adenoid surfaces of children with chronic rhinosinusitis (CRS). We also intended to determine and analyze the potential correlation between the pre- and post-adenoidectomy differences in the nasal bacterial profile and clinical prognosis. Methods The clinical information of pediatric patients was collected. All the children underwent adenoidectomy (with or without tonsillectomy), and swab samples were collected during the operation. Visual analog scales (VAS) were used at 3, 6, and 12 months postoperatively. At the 12-month follow-up examination, swab samples were collected again. PCR amplification was performed of the v3-v4 variable regions of 16S rRNA of the collected specimens, as well as high-throughput sequencing using the Illumina platform. The species information was obtained by OTUs clustering, species annotation, and α-diversity analysis. Results Twenty-two male and eight female pediatric patients were included in the investigation The most abundant genus level bacterial representatives on the nasal surface before adenoidectomy were Moraxella catarrh, Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus aureus, whereas on the surface of adenoids, they were Streptococcus pneumonia, Haemophilus influenza, Nucleobacter, and Moraxella catarrhalis. One year postoperatively, the bacteria with the highest abundance on the nasal surface at the genus level were Moraxella catarrhalis, Streptococcus pneumonia, Staphylococcus aureus, and non-culturable Dolosigranulum. One year postoperatively, the bacterial richness in the nasal cavity was significantly higher than at baseline ( P < .05). Furthermore, the subjective nasal score of all children significantly decreased at 3, 6, and 12 months postoperatively ( P < .01). Conclusion The preoperative bacterial abundance of the nasal cavity and the adenoid surfaces was similar, showing a clear correlation. No single specific bacterium was established to be a dominant species associated with the development of CRS in children. The post-adenoidectomy bacterial richness in the nasal cavity was significantly increased, which may be closely related to the relief of postoperative sinusitis symptoms.

Objective:To review the clinical and radiological presentation and management of infected nasal dermal sinus cysts（NDSC） in children. Methods:Clinical data were collected from 59 NDSC children with secondary fronto-orbital area infection who presented to Beijing Children's Hospital from January 2007 to December 2021. All patients underwent preoperative imaging workup, including MRI and CT. All patients underwent endoscopic excision of a NDSC under general anesthesia. Results:A total of 59 patients were included in the study,while 58 presented with a sinus, 1 presented with a cyst.The main lesions of NDSC included nasal root in 20 cases （33.9%）, nasal bridge in 34 cases （57.6%）, nasal tip in 4 cases （6.8%）, and nasal tip and nasal root in 1 case （1.7%）. The depth of lesions included 6 cases （10.2%） of superficial type of nasal frontal bone, 33 cases （55.9%） of nasal frontal bone, 19 cases （32.2%） of intracranial epidural type, and 1 case （1.7%） of intracranial epidural type. The main sites of infection included inner canthus in 15 cases （25.4%）, nasal dorsum in 22 cases （37.3%）, nasal root in 16 cases （27.1%）, and forehead in 6 cases （10.2%）. Among 59 cases, 7 cases （11.9%） were complicated with other diseases, and 4 cases（6.8%） had external nasal deformities. Surgical approaches included transverse incision in 12 cases（20.3%）, minimal midline vertical incision in 41 cases （69.5%）, external rhinoplasty in 4 cases （6.8%） and bicoronal incision with vertical incision in 2 cases （3.4%）. The range of lesions was completely consistent with MRI results.All cases were successfully operated without one-stage nasal dorsum reconstruction. All patients were followed up from 7 to 173 months（average 52.2 months）. There were 6 cases of recurrence, all of which were in situ recurrence. The operation was performed again, and no recurrence has occurred since the follow-up, No nasal deformity was noted, and cosmetic outcome were favorable for all patients. Conclusion:NDSC infection in children with midfacial infection as the first symptom is rare in clinical practice, and its manifestations are diverse. Early diagnosis and rational treatment are very important to improve the cure rate.Preoperative high resolution MRI combined with CT scanning is of great significance in judging the course of NDSC, especially the intracranial extension. The treatment goal is to achieve minimally invasive and individualized treatment under the premise of complete excision of the lesion, and take into account the cosmetic needs.

目的 为制订儿童急性细菌性鼻窦炎(acute bacterial rhinosinusitis,ABRS)的眼眶并发症诊疗流程、建立随访体系提供依据.方法 回顾性分析2009—2019年首都医科大学附属北京儿童医院收治的ABRS眼眶并发症住院患儿的临床、影像特点、细菌培养结果和治疗方式等信息.结果 2009—2019年首都医科大学附属北京儿童医院诊治ABRS眼眶并发症92例患儿中发病年龄处于新生儿期9例(0～30d),婴儿期(1～12个月)17例,幼儿期(1～3岁)26例,小龄儿童(3～10岁)31例,大龄儿童(10～18岁)9例;男48例,女44例.根据钱德勒分型标准,眶周蜂窝织炎(preseptal cellulitis,PC)12例,眶骨膜下脓肿(subperiosteal abscess,SPA)4例,眶内蜂窝织炎(orbital cellulitis,OC)46例,眶内脓肿(orbital abscess,OA)30例;手术者23例,其中,鼻内镜下鼻窦开放术6例(同时行眶减压术3例),体表切开引流者术17例.手术病例获得的脓液均送细菌培养鉴定,其中金黄色葡萄球菌8例,包括耐甲氧西林金黄色葡萄球菌(methicillin-resistant S aureus,MRSA)2例;星座链球菌1例,无致病菌生长5例.结论 重型病例症状以眼球突出/活动受限和视力下降为主,轻型病例以眼睑红肿及全身症状为主.病原微生物培养结果以金黄色葡萄球菌为主.