OBJECTIVES: Acute rhinosinusitis is an inflammatory process that lines the nasal cavity and paranasal sinuses. Complications are uncommon, seem to occur more often in children than in adults, and are linked to anatomical relationships between the sinuses and the other structures of the head. Simultaneous complications involving the orbit and the intracranial space are extremely rare and should be aggressively treated, as they pose a high risk of mortality. We report a case of orbital and intracranial complications in a child and correlate it with the literature. CASE REPORT: P. S. S., 12 years of age, presented with a history of nasal congestion, runny nose, and headache, which started 1 week prior with no clinical improvement from oral antibiotics. He was hospitalized and subsequently developed a worsening headache, purulent rhinorrhea, epistaxis, fever, and right periorbital edema. He was started on broad-spectrum intravenous antibiotics. Computed tomography (CT) of the paranasal sinuses showed pansinusitis and a pronounced increase in the volume of soft tissues in the frontotemporal region with discrete gas bubbles between and pneumocephalus. The patient had a generally poor condition, amaurosis, ptosis, and right hemiparesis. A contrast CT scan showed epidural and subdural empyema, and continued presence of pneumocephalus. Endoscopic drainage of the sinuses, a right subperiosteal abscess, and an intracranial abscess were performed, along with administration of intravenous antibiotics and clinical and neurological monitoring. The patient improved the important initial framework and was discharged without sequelae or complications. CONCLUSION: Although uncommon, if complicated rhinosinusitis is suspected in children, it should be diagnosed early in order to institute appropriate treatment and to reduce the morbidity and mortality in these patients.