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Management of orbital subperiosteal abscess in children
R Rahbar1, C D Robson, R A Petersen
1Department of Otolaryngology and Communication Disorders, The Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA. rahbar@a1.tch.harvard.edu
Insights
Transnasal endoscopic drainage is an effective and safe treatment for pediatric orbital subperiosteal abscess (SPA). This minimally invasive approach offers comparable outcomes to external drainage with shorter hospital stays.
Area of Science:
- Ophthalmology
- Pediatric Otolaryngology
- Surgical Innovation
Background:
- Orbital subperiosteal abscess (SPA) is a serious condition in children.
- Management traditionally involves antibiotics and surgical drainage.
- Transnasal endoscopic drainage is an emerging minimally invasive option.
Purpose of the Study:
- To establish guidelines for managing pediatric orbital subperiosteal abscess (SPA).
- To evaluate the efficacy and safety of transnasal endoscopic drainage for pediatric SPA.
Main Methods:
- Retrospective review of 19 pediatric SPA patients (1997-1999).
- Treatment modalities included transnasal endoscopic drainage, external drainage, and antibiotics alone.
- Analysis of clinical factors, radiographic findings, and surgical outcomes.
Main Results:
- Bilateral pansinusitis was the most common etiology.
- Proptosis was a significant predictor for surgical intervention.
- Transnasal endoscopic drainage (n=11) showed shorter hospital stays (median 5 days) compared to external drainage (n=3, median 7 days).
Conclusions:
- Transnasal endoscopic drainage is a safe and effective treatment for medially located pediatric orbital subperiosteal abscesses.
- This approach offers advantages over external drainage, including reduced hospital stay.
- Guidelines should consider endoscopic drainage as a primary surgical option for suitable cases.
Objectives:
To present guidelines for the management of an orbital subperiosteal abscess (SPA) in children and to assess the efficacy and safety of transnasal endoscopic drainage of an orbital SPA.
Setting:
Tertiary care children's hospital.
Patients:
Nineteen patients treated for an SPA between July 1997 and December 1999. The age of the patients ranged from 17 months to 14 years (mean, 6 years). The male-female ratio was 10:9. Treatment modalities included transnasal endoscopic drainage (n = 11), external drainage (n = 3), and intravenous antibiotics alone (n = 5).
Results:
Bilateral pansinusitis was the most common cause. All patients received an initial trial of intravenous antibiotics. Based on the Fisher exact test, no statistically significant differences were detected for age, sex, presence of gaze restriction, and radiographic findings. Based on multiple logistic regression, degree of proptosis was the only significant multivariate predictor of surgery (P =.003). The estimated probability of surgery was 6% when there was no proptosis, and 92% for 2 mm of proptosis. The location of the SPA determined the route of surgical drainage. Eleven patients with a medially based SPA underwent drainage via the transnasal endoscopic approach, and 3 with a superior SPA underwent drainage externally. The external approach was associated with a longer hospital stay (median, 7 days) than either the endoscopic or the intravenous antibiotic approach (median, 5 days).
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