Case Of Subperiosteal Abscess Research Articles

Orbital subperiosteal abscess in adolescents and adults: predictors and outcomes of nonsurgical management and surgical approaches

ABSTRACT Purpose The aim of this study was to assess predictors and outcomes of subperiosteal abscess (SPA) management in adolescents and adults at two tertiary care centers. Methods This retrospective cohort study included cases of SPA from January 1 2000 to October 9 2022 at two institutions. Patients 9 years or older were categorized into surgical and nonsurgical cohorts. Surgical subgroups included those who underwent functional endoscopic sinus surgery (FESS) alone, external (transcutaneous or transconjunctival) orbitotomy alone, or combined FESS and external surgery. The presented features were assessed as potential treatment predictors. Outcomes included length of stay (LOS), final best-corrected visual acuity (BCVA), readmission rate, and reoperation rate. Results Of the 159 SPA cases included, 127 (79.9%) underwent surgery and 32 (20.1%) were managed nonsurgically. The nonsurgical cohort was younger (p = .003) with smaller abscesses (p < .001) that were more likely to be medial (p < .001). The nonsurgical cohort had shorter LOS (p < .001); final BCVA and readmission rates were similarly favorable. Abscess location was correlated with surgical approach. Superior SPA that underwent FESS or external surgery alone had higher reoperation rates (57.1.0% and 58.3%, respectively) than combined (17.9%). External approach and FESS alone resulted in lower reoperation rates (15.4% and 15.0%, respectively) than combined (27.3%) for medial SPA. Subgroup analysis in the sinusitis cohort yielded similar results. Conclusions A trial of nonsurgical management may be safe and effective for select patients aged 9 years and older with sinusitis-derived, medial, and small SPA. When surgery is indicated, approach should be guided by abscess location to minimize reoperation risk.

Pott's Puffy Tumor: A Rare, Life-Threatening Presentation ofPeriorbital Edema.

Pott's puffy tumor (PPT) describes forehead swelling with associated frontal bone osteomyelitis and a subperiosteal abscess (SPA) requiring a high suspicion index for optimal outcomes. PPT is a life-threatening complication of frontal sinusitis typically found in adolescents. Our case is one of the youngest in the literature. This report describes a 3-year-old patient who developed multifocal abscesses in the epidural space with frontal and orbital SPA, requiring surgical intervention. Additionally, her course was complicated by a superior sagittal venous thrombosis, a complication commonly associated with PPT. We present an unusual case of orbital SPA and aim to highlight a life-threatening pediatric condition that is often underrecognized.

A Case of Subperiosteal Abscess that was Successfully Approached Endoscopically via the Frontal Sinus with Minimal Supplemental External Incision

A Case of Subperiosteal Abscess that was Successfully Approached Endoscopically via the Frontal Sinus with Minimal Supplemental External Incision

Our Experience in the Management of Orbital Complications in Acute Rhinosinusitis

Background and objectiveThe spread of an infection from the paranasal sinuses is rare but severe. Between 4% and 20% of all rhinosinusitis can become complicated, orbital involvement being the most frequent (60–75%). Orbital complications are more common in children but more severe in adults. We aim to analyse the epidemiological characteristics of these patients and to propose a management algorithm. Materials and methodsWe carried out a retrospective review of 21 patients with orbital complications of acute rhinosinusitis diagnosed in the same institution from 2005 to 2018. The diagnosis was based on clinical history, endoscopic examination and imaging tests. All patients received an intravenous antibiotic and were assessed by ophthalmology. An immediate surgical treatment was performed in the case of an abscess or poor response to medical management. ResultsThe average age was 24 years. Fifty-two percent were males and 48% females. According to Chandler's classification, 43% (9/21) had preseptal cellulitis (7 adults and 2 children), 10% (2/21) orbital cellulitis (one adult and one child), 43% (9/21) subperiosteal abscess (2 adults and 7 children), there was one case of orbital abscess in an adult and there were no cases of cavernous sinus thrombosis. A CT scan was performed in all patients and the cases of subperiosteal or orbital abscess were treated surgically, except 2 paediatric patients (<4 years) with a small and medial subperiosteal abscess (<4 mm) who responded well to medical treatment. The surgical approach is performed by endonasal endoscopy, perforating the lamina papyracea in cases of subperiosteal abscess and also opening the periorbita in orbital abscess. It was combined with an external palpebral approach in the 4 cases that presented a superior or lateral abscess. Two young adults (10%) presented an intracranial complication concomitantly. ConclusionOrbital complications of acute rhinosinusitis are rare but potentially severe. It is important to be aware of and suspect them in order to act quickly. It is essential to define the location and extension of the infection for correct management, as well as multidisciplinary treatment. The surgical approach is performed by endonasal endoscopy. It is limited by abscesses located on the roof of the orbit or on the lateral wall, when a combined external palpebral approach is required.

Nuestra experiencia en el manejo de las complicaciones orbitarias en la rinosinusitis aguda

Background and objectiveThe spread of an infection from the paranasal sinuses is rare but severe. Between 4% and 20% of all rhinosinusitis can become complicated, orbital involvement being the most frequent (60-75%). Orbital complications are more common in children but more severe in adults. We aim to analyse the epidemiological characteristics of these patients and to propose a management algorithm. Materials and methodsWe carried out a retrospective review of 21 patients with orbital complications of acute rhinosinusitis diagnosed in the same institution from 2005 to 2018. The diagnosis was based on clinical history, endoscopic examination and imaging tests. All patients received an intravenous antibiotic and were assessed by ophthalmology. An immediate surgical treatment was performed in the case of an abscess or poor response to medical management. ResultsThe average age was 24 years. Fifty-two percent were males and 48% females. According to Chandler's classification, 43% (9/21) had preseptal cellulitis (7 adults and 2 children), 10% (2/21) orbital cellulitis (one adult and one child), 43% (9/21) subperiosteal abscess (2 adults and 7 children), there was one case of orbital abscess in an adult and there were no cases of cavernous sinus thrombosis. A CT scan was performed in all patients and the cases of subperiosteal or orbital abscess were treated surgically, except 2 paediatric patients (<4 years) with a small and medial subperiosteal abscess (<4mm) who responded well to medical treatment. The surgical approach is performed by endonasal endoscopy, perforating the lamina papyracea in cases of subperiosteal abscess and also opening the periorbita in orbital abscess. It was combined with an external palpebral approach in the 4 cases that presented a superior or lateral abscess. Two young adults (10%) presented an intracranial complication concomitantly. ConclusionOrbital complications of acute rhinosinusitis are rare but potentially severe. It is important to be aware of and suspect them in order to act quickly. It is essential to define the location and extension of the infection for correct management, as well as multidisciplinary treatment. The surgical approach is performed by endonasal endoscopy. It is limited by abscesses located on the roof of the orbit or on the lateral wall, when a combined external palpebral approach is required.

Imaging of orbital cellulitis in children: about 56 cases

Les cellulites orbitaires de l'enfant sont rares mais potentiellement graves, le diagnostic est principalement basé sur l'examen clinique et l'imagerie (tomodensitométrie ou IRM). Le but de ce travail est d'illustrer le rôle de l'imagerie, essentiellement la TDM, dans le diagnostic et la prise en charge de cette pathologie. Il s'agit d'une étude rétrospective portant sur 56 cas de cellulite orbitaire, colligés durant six années au service de radiologie de l'hôpital mère-enfant du CHU Mohammed VI de Marrakech (de janvier 2011 à octobre 2017), explorés par TDM crânio-orbitaire. L'âge moyen des patients était de 5 ans, avec une légère prédominance féminine. La porte d'entrée était dominée par l'atteinte sinusienne retrouvée chez 22malades. L'analyse des résultats tomodensitométriques a noté 37 cas de cellulite préseptale (66%), 3 cas de cellulite rétroseptale isolée (5%), 16 cas de cellulite mixte (28%), 8 cas d'exophtalmie (14%) et 4 cas d'abcès sous-périosté (7%). Les cellulites orbitaires de l'enfant sont des infections graves, entravant le pronostic vital à court terme et le pronostic fonctionnel visuel à moyen et long terme, le diagnostic positif est clinique. L'imagerie joue un rôle important dans le diagnostic topographique et étiologique, ainsi que pour guider le traitement.

Management of frontal sinusitis–associated subperiosteal abscess in children less than 9 years of age

To investigate practice patterns for cases of subperiosteal abscess (SPA) with concomitant frontal sinusitis to identify factors favorable to medical management in children <9years of age. The medical records of all pediatric cases of orbital and periorbital cellulitis admitted at a tertiary care center from 1999-2014 were reviewed retrospectively. Cases were included if radiography demonstrated sinusitis-associated SPA in children <9years of age. Cases of SPA with ipsilateral frontal sinusitis were compared to cases of SPA without ispilateral frontal sinus involvement. A total of 21 cases with ipsilateral frontal sinusitis and 76 without were included. Patients with frontal sinusitis had a higher incidence of nonmedial SPA compared to those without frontal sinus involvement (6/21 vs 5/76, P=0.01). Yet a majority of SPAs in the frontal sinusitis group were located medially (15/21 [71%]). All patients with superior or superomedial SPA underwent early surgical intervention. However, 14 of 15 patients (93%) in the frontal sinusitis cohort with medial SPAs were managed successfully with medical therapy alone. Medical management of frontal sinusitis-associated SPA appears safe for select children <9years of age with medial abscess. Although frontal sinusitis is cited as a criterion for surgical drainage of SPA, this criterion should be refined to frontal sinusitis with superiorly located abscesses.

Medical Management Versus Surgical Intervention of Pediatric Orbital Cellulitis: The Importance of Subperiosteal Abscess Volume as a New Criterion

To investigate age and frontal sinusitis as indications for the surgical management of pediatric orbital cellulitis with subperiosteal abscess (SPA) and to create an SPA volume criterion that would favor nonsurgical management. A retrospective chart review was performed to find all patients age 18 years and younger who presented to Hasbro Children's Hospital with orbital cellulitis secondary to sinusitis with an SPA from 2005 to 2009. SPA volume was measured using a CT ruler at the largest axial, coronal, and sagittal dimensions. Student t testing was used for statistical analysis. Twenty-nine patients were included: 8 (27.6%) were managed surgically and 21 (72.4%) were managed medically. The mean age of patients undergoing surgical management was 7.0 years old versus medical management 6.1 years old and was statistically similar (p < 0.001). The age range of patients undergoing surgical management was 17 months to 11 years versus 4 months to 13.4 years for medical management. The mean volume of abscesses needing surgery were larger (3,446.3 mm) than abscesses not needing surgery (420.5 mm) (p < 0.04). Volumes of <1,250 mm did not require surgical management (p < 0.001). The frontal sinuses were visualized on CT scan in 17 patients; frontal sinusitis was found in 11 of 17 (64.7%) patients; of these 11 patients, 4 (36.4%) underwent surgical drainage and only 2 (18.2%) showed positive culture results. The 2 (18.2%) patients who had positive culture results had an SPA volume that was ≥ 1,250 mm. The volume of SPA seemed to be the most important criterion in determining medical versus surgical management. The volumes of abscesses needing surgery were larger than the volumes of abscesses not needing surgery. Volumes of <1,250 mm did not require surgical management. Most cases of SPA with concurrent frontal sinusitis do not require surgical intervention. The cases of frontal sinusitis requiring surgical intervention always had concurrent SPA volumes of ≥ 1,250 mm. Patients both under 9 years old and ≥ 9 years old required surgical intervention with SPA volumes of <1,250 mm being a consistent determining factor.

眼窩骨膜下膿瘍の治療に関する臨床的検討

Subperiosteal abscess is generally defined as the collection of pus between the periorbita and the orbital wall, and usually results from paranasal sinus infection. Early, appropriate evaluation and management observing signs and symptoms of orbital inflammation are required to prevent blindness. We report 5 cases of subperiosteal abscess caused by paranasal sinus problems. We used endoscopic ethmoidectomy with puncture or endonasal endoscopic drainage of the abscess and found orbital complications in 4. We used conservative therapy in 1 with no visual acuity. We discuss pathogenesis and surgical indications and approaches. Three of 4 patients with mild visual acuity and treated with surgical procedure were cured without sequalae. We successfully managed the superior subperiosteal abscess with an endoscopic endonasal approach. One of 4 patients who had severe vision loss, however, was cured without any recovery of loss of vision after surgical drainage to decrease orbital pressure. The endscopic endonasal approach is more useful in managing both sinus disease and orbital complications than external ethmoidectomy.

안와내 골막하 농양을 동반한 소아 부비동염 3례

Infections of the orbit in children usually present as a complication of sinusitis and can result in blindness and death. The treatment of orbital complication from sinusitis is surgical intervention whenever antibiotic treatment fails. Recently we experienced 3 cases of subperiosteal abscess. Two out of 3 childrens with proven subperiosteal abscess and sinusitis on computed tomographic scans failed antibiotic treatment and required surgical drainage. In these cases, orbital complications were resolved via transnasal endoscopic drainage of the abscess. The third case was successfully managed with intravenous antibiotics. So, we report these cases with a review of literature. (J Clinical Otolaryngol 2000;11:298-303)