Management of subperiosteal orbital abscess in pediatric population: a comparative study

To assess clinical and radiological parameters as predictive factors for surgical intervention in children diagnosed with subperiosteal orbital abscess (SPOA).

A retrospective study conducted over 8 years (2016-2023) at a tertiary medical center. A total of 624 children with periorbital/orbital cellulitis were assessed for eligibility. Orbital imaging was performed on 107 children, and 45 were diagnosed with SPOA and included for this study. Patients diagnosed with SPOA were divided into two groups: conservative treatment (n = 20) and surgical intervention (n = 25). Clinical and laboratory parameters were evaluated. Radiological parameters, including abscess volume, abscess dimensions, and proptosis, were measured using three-dimensional imaging techniques.

Age, fever, leukocyte count, and C-reactive protein levels did not significantly differ between the surgical and conservative groups. However, neutrophils to lymphocytes ratio (NLR) was significantly higher in the surgical group (8.1 vs 3.64; p < 0.001). Radiological findings showed that both absolute radiological proptosis (19 mm vs 16.1 mm; p < 0.001), and the difference in proptosis between the affected and fellow eyes (4 mm vs 2.1 mm; p < 0.001) were significantly greater in the surgical group. A relative abscess volume ≥0.11 mL was found to predict the need for surgery with a sensitivity of 88% and specificity of 85%. Anteroposterior and craniocaudal dimensions of the abscess were significantly larger in the surgical group.

NLR and radiological parameters, particularly proptosis and abscess volume, are valuable predictors of surgical intervention in children with SPOA. These findings suggest that combining clinical and radiological assessments can improve decision making for treating pediatric orbital infections, potentially guiding timely surgical management.