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Characteristics and management of pediatric medial subperiosteal orbital abscesses
Nathan E Lu1, Lauren A Gardiner1, Jennifer L McCoy2
1Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Introduction:
Subperiosteal orbital abscesses (SPOA) are the most common suppurative complications of acute bacterial sinusitis. Medial SPOAs arise from infection of the ipsilateral ethmoid sinus and favor initial conservative management reserving surgical drainage for patients who do not demonstrate clinical improvement. No standard algorithm defining medical versus surgical treatment of medial SPOAs exist in the pediatric population.
Objectives:
To identify a size cutoff for medial SPOAs to predict the likelihood for surgical drainage.
Methods:
This is a retrospective review of patients with medial SPOAs at a tertiary care center from 2003 to 2017. Diagnosis of SPOA was based on radiographic findings. Variables included are patient demographics, antibiotic therapy, surgical intervention, and length of stay.
Results:
82 patients with a medial SPOA were included with an average age at presentation of 6.27 (range 0-15) years were included in this study. 62 patients were male (75.6 %), and 20 were female (24.4 %). The average abscess length was 16.1 mm, range 4.5-30.7 mm. The average abscess width was 4.17 mm, range 1.5-14.6 mm. The odds ratio for surgical treatment with every 1 mm increase in abscess width was 1.89 (95CI:1.33-2.69, p < 0.001). Abscesses over 3.6 mm width were 6.65 times more likely to undergo surgical drainage than those less than 3.6 mm (OR:6.65, 95CI:2.52-17.54, p < 0.001). The average(SD) length of stay was 5.4(3.0) days for patients who underwent surgery and 4.0(0.9) days for patients treated with conservative measures, p < 0.001.
Conclusion:
Medial SPOAs greater than 3.6 mm were more likely to undergo surgical drainage; however there was no difference in the likelihood of drainage between anteriorly and posteriorly based medial abscesses. These findings help further characterize the landscape of pediatric subperiosteal abscesses that are managed with surgical drainage.
Insights
Medial subperiosteal orbital abscesses (SPOA) wider than 3.6 mm in children are significantly more likely to require surgical drainage. This finding aids in determining optimal treatment strategies for pediatric SPOA.
Area of Science:
- Ophthalmology
- Pediatric Otolaryngology
- Infectious Diseases
Background:
- Subperiosteal orbital abscesses (SPOA) are common complications of acute bacterial sinusitis.
- Medial SPOAs originate from ethmoid sinus infections and often receive initial conservative management.
- A clear treatment algorithm for pediatric medial SPOAs is lacking.
Purpose of the Study:
- To establish a size threshold for medial SPOAs to predict the need for surgical intervention.
- To guide clinical decision-making in the management of pediatric medial SPOAs.
Main Methods:
- Retrospective review of pediatric patients diagnosed with medial SPOA between 2003 and 2017.
- Radiographic findings were used for SPOA diagnosis.
- Analysis of patient demographics, antibiotic use, surgical intervention, and length of stay.
Main Results:
- 82 pediatric patients with medial SPOA were analyzed (average age 6.27 years).
- Abscess width was a significant predictor of surgical drainage; an increase of 1 mm in width increased the odds of surgery by 1.89.
- Medial SPOAs exceeding 3.6 mm in width were 6.65 times more likely to require surgical drainage.
Conclusions:
- A medial SPOA width greater than 3.6 mm is associated with a higher likelihood of surgical drainage.
- Abscess location (anterior vs. posterior) did not influence the likelihood of surgical drainage.
- These findings contribute to characterizing pediatric medial SPOAs managed surgically.
