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Subperiosteal orbital abscess: volumetric criteria for surgical drainage
Florian Tabarino1, Monique Elmaleh-Bergès2, Stéphanie Quesnel1
1Pediatric otorhinolaryngology department, Robert Debré Hospital, APHP, Université Paris 7 Denis Diderot, Sorbonne Paris Cité, Paris, France.
Insights
Predictive factors for surgical management of subperiosteal orbital abscess in children include exophthalmos and abscess volume. These CT-scan measurements help determine the need for surgery in acute pediatric orbital cellulitis cases.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Radiology
Background:
- Acute pediatric orbital cellulitis (APOC) can lead to subperiosteal orbital abscess.
- Surgical intervention is sometimes necessary for effective treatment.
Purpose of the Study:
- To identify predictive factors for surgical management of subperiosteal orbital abscess in children.
- To correlate clinical and radiological findings with surgical intervention decisions.
Main Methods:
- Retrospective monocentric study of children with APOC (2000-2011).
- Analysis of clinical, biological, and radiological data, including CT-scans.
- Measurement of abscess dimensions and volume; calculation of exophthalmos.
Main Results:
- 38.6% of APOC patients developed a subperiosteal orbital abscess.
- Abscess volume and exophthalmos positively correlated with surgical drainage.
- Surgery was more likely with exophthalmos >4mm (57.9%) or abscess volume >500mm³ (100%).
Conclusions:
- Exophthalmos and abscess volume on CT-scan are key predictors for surgery in pediatric subperiosteal orbital abscess.
- These factors guide surgical decisions, especially in the absence of visual complications.
Objective:
To investigate predictive factors of surgical management of subperiosteal orbital abscess in children.
Methods:
A retrospective monocentric study was conducted between 2000 and 2011 with children hospitalized for acute pediatric orbital cellulitis (APOC). Clinical, biological and radiological data as well as medical and surgical management were collected and analyzed. All patients received intravenous antibiotics and underwent a CT-scan. Orbit and subperiosteal intraorbital abscess dimensions were measured on axial and coronal planes and the abscess volume was calculated using a spheroid model.
Results:
Eighty-three children with APOC (mean age: 4.5 years) were included, 53 were boys (63.9%). Thirty-two children (38.6%) presented with a subperiosteal orbital abscess. Mean abscess volume was 570mm(3) and mean exophthalmos was 4.7mm. Twenty patients were treated surgically, 11 of which by an endoscopic approach. A positive correlation was observed between the volume of the abscess or exophthalmos and surgical drainage: 57.9% of patients underwent surgery when exophthalmos was >4mm, 29.4% between 2 and 4mm, and none when <2mm. All patients with an abscess volume >500mm(3) or >5% of orbital volume were operated on whereas only 30% or 39% of patients, respectively, in case of smaller volumes (P<0.05).
Conclusion:
Surgery for subperiosteal orbital abscess is usually performed in case of visual complications or unfavorable medical outcome. The importance of the exophthalmos and the volume of the abscess measured on the CT-scan are predictive factors of surgery in children with subperiosteal orbital abscess without visual complications.
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