Although complications of sinusitis in children have lessened remarkably since the advent of antibiotics, nevertheless they still occur. In a 25-year period at the Hospital for Sick Children, 6,770 patients with the diagnosis of sinusitis were reviewed and 159 of these had orbital-facial complications. Surgical intervention was necessary in 17 to prevent more serious complications. Although there were no deaths in non-malignant disease, two patients developed permanent optic atrophy, presumably because of delayed surgical drainage. On occasion, malignant disease may simulate inflammatory processes.