Pediatric sinusitis and subperiosteal orbital abscess formation: diagnosis and treatment

Twenty-two children with subperiosteal orbital abscesses were treated at St. Louis Children's Hospital between 1983 and 1992. Eighteen patients were otherwise in good health; four patients had cystic fibrosis, mucoceles, or were immunocompromised. All patients were treated with intravenous antibiotics and abscess drainage. CT scans were obtained preoperatively in each case. Ten patients were treated with endoscopic ethmoidectomy and abscess drainage, and 11 were treated with external ethmoidectomy and abscess drainage. One child was initially treated with abscess drainage and an elective endoscopic ethmoidectomy was performed later. There were no cases of permanent visual loss or neurologic sequelae. Culture results were positive in 14 cases and mixed infections were common. Complications included recurrent abscess, cerebritis, and empyema. We recommend combined medical and surgical treatment for all children with subperiosteal orbital abscess. We feel that endoscopic ethmoidectomy and abscess drainage offers some advantages over external ethmoidectomy and abscess drainage.