Management of orbital subperiosteal abscess

To discuss the role of surgical intervention in subperiosteal orbital abscess (SPOA) using a retrospective medical chart review.

A retrospective medical chart review of subjects who were diagnosed and surgically treated for SPOA between 2002 and 2009.

Ten patients were identified (8 males and 2 females). All SPOAs were unilateral. Of 10 SPOAs, 7 were on the left and 3 were on the right. Six of these were medially located abscesses, whereas 4 were superior abscesses. Of the 6 medially located abscesses, 4 were treated with transnasal endoscopy (TNE). External (E) drainage was needed in 2 of the medially located abscesses. In one of these abscesses, the surgeon was forced to drain the abscess with TNE and turned to E drainage. In the other, TNE was performed first. Despite medical therapy and TNE, patients' orbital symptoms did not resolve. A second operation was performed with E drainage. Four of the superiorly based SPOAs were treated with combined E-TNE approach.

External drainage of the SPOA is needed on 6 (60%) of the patients in this study. Superiorly located abscesses were initially treated with E drainage, and then functional endoscopic sinus surgery was performed to treat the affected sinuses. Transnasal endoscopic management failed in 2 patients, hence E drainage was needed. The characteristics of the patients are presented and discussed in view of a surgical approach.