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Updated: Jun 20, 2026
Endoscopic Cholesteatoma Surgery
Published on: January 19, 2022
Endoscopic sinus surgery for medial orbital subperiosteal abscess in children
Lela Migirov1, Arkadi Yakirevitch, Lev Bedrin
1Department of Otolaryngology Head and Neck Surgery, Sheba Medical Center, Tel Hashomer, Israel. sabim@bezeqint.net
Insights
Endoscopic sinus surgery offers a safer and faster recovery for children with medial orbital subperiosteal abscess (MOSA). This approach avoids complications like scarring and delayed healing associated with external ethmoidectomy.
Area of Science:
- Ophthalmology
- Otorhinolaryngology
- Pediatric Surgery
Background:
- Medial orbital subperiosteal abscess (MOSA) is a serious condition in children.
- Traditional treatment involves external ethmoidectomy, which can lead to complications.
Purpose of the Study:
- To evaluate the efficacy and safety of endoscopic management of pediatric MOSA.
- To compare endoscopic drainage with external ethmoidectomy for MOSA treatment.
Main Methods:
- Retrospective review of 22 children with MOSA.
- Six children underwent endoscopic sinus surgery (group 1).
- Sixteen children underwent external ethmoidectomy (group 2).
Main Results:
- Endoscopic group had no postoperative sequelae; external group experienced scarring, delayed healing, and recurrent infections.
- Faster healing (4.2 vs. 8.6 days) and shorter hospital stays (6.0 vs. 9.9 days) in the endoscopic group.
- Microbiology revealed Streptococcus pneumoniae and Haemophilus influenzae in both groups, with negative cultures in some endoscopic cases due to prior antibiotics.
Conclusions:
- Endoscopic approach is recommended for MOSA treatment in children.
- External ethmoidectomy should be reserved for superior orbital abscesses.
Objective:
To present our experience with endoscopically managed medial orbital subperiosteal abscess (MOSA) in children and to compare the results with external drainage of the abscess.
Methods:
A retrospective record review was conducted on 22 children with MOSA, of whom 6 underwent drainage by endoscopic sinus surgery (group 1) and 16 underwent external ethmoidectomy (group 2). MOSA was diagnosed by computed tomography of the orbits.
Results:
There were no postoperative sequelae in children treated endoscopically, in contrast to facial scarring, delayed healing, stitch abscess, unresolved diplopia, or recurrent periorbital cellulitis with or without subperiosteal abscess following external drainage. Streptococcus pneumoniae and Haemophilus influenzae were isolated in three children and one child in group 1, respectively, whereas the cultures were negative in the other two group 1 children who received antibiotics prior to admission. Streptococcus species were also the most common isolates in group 2 (50%), followed by H. influenzae (19%). The mean duration of postoperative healing was 4.2 +/- 1.9 days (range 2-7 days) in group 1 and 8.6 +/- 4.2 days (range 5-17) in group 2 (p = .005). The mean respective hospital stay was 6.0 +/- 2.0 days (range 4-9 days) and 9.9 +/- 4.2 days (range 5-18 days) (p = .02). One group 2 child with residual disease underwent revision external ethmoidectomy 5 weeks after the initial procedure. Recurrent periorbital cellulitis was successfully managed conservatively in two group 2 children, 3 and 10 months postoperatively in one child, and 3 months and 6 years postoperatively in the other.
Conclusion:
We recommend exclusive use of an endoscopic approach for treating MOSA and saving external ethmoidectomy for drainage of superior orbital abscesses.
