Drainage Of Subperiosteal Abscess Research Articles

Recurrent Orbital Subperiosteal Abscess in Patient with Nasopharyngeal Carcinoma

Introduction : Subperiosteal abscess (SPA) is a rare finding in cancer patients with orbital cellulitis. Severe complications associated with this condition are permanent visual loss, intracranial extension, and death.
 Case Illustration : A 38-year-old male with history of nasopharyngeal carcinoma (NPC) came with progressive right eyelid swelling, non-axial proptosis, and visual acuity was NLP. CT scan revealed right SPA associated with frontal sinusitis. NPC staging was T3N2M0. Despite the treatment of intravenous antibiotics and drainage incision of SPA, there was recurrence of right SPA two weeks after procedure and re-staging revealed T4N3M0. A joint operation with otolaryngology department to do debulking of the mass, frontal sinus surgery, and drainage incision was held. Culture resulted in Talaromyces marneffei. Patient was assessed with talaromycosis and given itraconazole for ten weeks. Moreover, patient came again with proptosis seven weeks postoperatively. Re-drainage incision was performed and clinical presentation was improved.
 Discussion : This case describes rare biological nature of NPC where extensive blockage of paranasal sinuses allows microorganism overgrowth and infection. The anatomical changes and cancer-related immunosuppression contribute to recurrent SPA. Chemotherapy and radiotherapy are ideal treatments for our patient, however, infection must be treated adequately first. Surgical interventionis needed to manage the infection by SPA drainage where antimicrobial has poor penetration into the abscess and debulking of tumor to clear the blockage of drainage pathway.
 Conclusion : Recurrent orbital SPA could happen in patients with NPC, therefore appropriate medical treatment and timely surgical intervention are essential in managing orbital SPA. Multidisciplinary management is required to optimize patient outcomes.

A Rare Cause of Orbital Cellulitis: Eikenella corrodens.

To The Editors: Eikenella corrodens is a small, nonmotile Gram-negative rod and is a member of the ordinary flora of the oral mucosa. Eikenella species can cause a wide variety of head and neck infections, such as sinusitis, preseptal cellulitis and orbital cellulitis in immunocompromised patients as well as in hosts with normal immunity.1,2 In the literature, there are few cases of orbital cellulitis caused by E. corrodens. We herein report 2 cases of orbital cellulitis due to Eikenella spp. as the complication of untreated sinusitis in previously healthy girls. The first case, a previously healthy 15-year-old girl, was admitted to the pediatric emergency department (PED) complaining of new-onset left eyelid swelling, painful eye movements and chemosis. On physical examination, her eye movements were limited and painful. Significant chemosis and ectropion were observed. Laboratory results were notable for leukocytosis (16000 cells/mm3) and increased C-reactive protein (CRP) (176 mg/L) levels. Orbital computed tomography (CT) revealed orbital cellulitis and subperiosteal abscess as a complication of sinusitis in the left orbit (Fig. 1). The treatment was administered as intravenous (IV) cefotaxime (300 mg/kg/day), vancomycin (60 mg/kg/day) and metronidazole (30 mg/kg/day). Orbital decompression and subperiosteal abscess drainage were performed. Abscess culture grew E. corrodens that was susceptible to penicillin (MIC:0.023), cefuroxime (MIC:1.00) and cefotaxime (MIC:0.064). Vancomycin and metronidazole were discontinued on day 3. After 14 days of IV cefotaxime treatment, she was discharged with oral cefuroxime, and the total treatment period was completed in 21 days.FIGURE 1.: The arrow marks show abcess and the stars show sinusitis in both pictures. A: The orbital CT reveal orbital cellulitis of the left eye and ethmoid sinusitis. B: Orbital CT represents the subperiosteal abscess in the medial extraconal area of the left orbita.The second case, a previously healthy 9-year-old girl, presented to the PED with a 4-day history of painful eye movements. On physical examination, eye movements were painful, and there was proptosis in her left eye. In the laboratory, acute phase reactants were normal (CRP:26 mg/L, procalcitonin:<0.06 µg/L) without leukocytosis (WBC:11500 cells/mm3). Orbital CT showed diffuse sinusitis and subperiosteal abscess in the left orbital medial extraconal region (Fig. 1). Treatment was arranged as IV cefotaxime, vancomycin and metronidazole. Orbital decompression and subperiosteal abscess drainage were performed. E. corrodens grew in abscess culture, which was susceptible to ampicillin (MIC:0,064), cefotaxime (MIC:0,16), clindamycin (MIC:0,75) and meropenem (MIC:0,16). Her treatment was continued with IV ampicillin-sulbactam (300 mg/kg/day) for 10 days. She was discharged with amoxicillin/clavulanic acid, and the total treatment was completed in 21 days. Acute sinusitis is a common condition that can cause severe complications due to expanding to the surrounding structures, including the eye and the brain.3 Orbital cellulitis is a rare but important complication of acute sinusitis, as it may result in vision loss.4 Although Streptococcus and Staphylococcus spp. are the most common, other less frequent oral flora members, including anaerobes and facultative anaerobic agents such as E. corrodens, may also cause the same clinical presentations. In routine culture, E. corrodens was challenging to detect due to growth in 72 hours in an atmosphere of 5%–15% CO2, 35–37 °C and 100% humidity.5E. corrodens is usually susceptible to penicillin, second- and third-generation cephalosporins, and carbapenem but is resistant to clindamycin, macrolide, metronidazole and aminoglycoside.2 Antibiotic susceptibility tests are important in terms of guiding for appropriate treatment. In summary, we present 2 previously healthy children who developed orbital cellulitis due to Eikenella corrodens. Early diagnosis, appropriate surgical drainage, and targeted medical treatment due to antibiotic susceptibility will improve the outcomes.

A child with refractory orbital cellulitis after water pipe smoking

Orbital cellulitis in children rarely occurs secondary to smoking water pipe. A 3-year-old girl who presented with fever, eyelid swelling, pain, and proptosis of the left eye for 4 days after water pipe consumption. The patient was given the usual course of antibiotics for a few days along with subperiosteal abscess drainage however no improvement was noticed for a week. Cultures were positive for methicillin-resistant Staphylococcus aureus and pseudomonas aeruginosa. Intravenous dexamethasone was co-administered in three courses for 3 weeks, during which residual symptoms was slowly resolving. In conclusion, attempt of dexamethasone in children can shorten hospital stay and augment full recovery.

Management of acute complicated mastoiditis at an urban, tertiary care pediatric hospital

To describe the presentation and management of acute complicated mastoiditis in children. Retrospective case series. An analysis of pediatric patients with acute complicated mastoiditis treated at an urban, tertiary care children's hospital from 2007 to 2014 was performed. Forty-eight patients presented with a total of 67 complications of acute mastoiditis. Mean age at presentation was 4.8 years (range = 0.1-15.3 years). The most common complications were subperiosteal abscess (n = 22, 45.8%), epidural abscess (n = 16, 33.3%), and sigmoid sinus thrombosis (n = 14, 29.2%). The most common pathogens isolated included Streptococcus pneumoniae (n = 14, 29.2%) and group A streptococcus (n = 10, 20.8%). Multidrug resistance was not associated with complication type. Surgical management included myringotomy ± tympanostomy tube placement in 46 (95.8%) patients (the only surgery in 10), drainage of subperiosteal abscess without mastoidectomy in 18 (37.5%) patients, and mastoidectomy in 21 (43.8%) total patients. Patients presenting with intracranial complications were the most likely to undergo a mastoidectomy. Anticoagulation was used in the management of nine of 14 (64.3%) patients presenting with sigmoid sinus thrombosis. Neurosurgical interventions (n = 7, 14.6% patients) were primarily performed to manage increased intracranial pressure. Subperiosteal abscess was the most common complication of acute mastoiditis, and when occurring as the sole complication was successfully managed with antibiotics and surgical intervention that did not include mastoidectomy. Epidural abscess and sigmoid sinus thrombosis were more prevalent than reported in prior series and were managed more aggressively. These patients were more likely to need neurosurgical interventions. 4. Laryngoscope, 127:2321-2327, 2017.

Endoscopic endonasal surgery in orbital decompression and orbital reconstruction

Objectiv The aim of this study was to clarify and evaluate the role and the outcome of endoscopic endonasal surgery in both orbital decompression and orbital reconstruction. Background Traditional external techniques are now known to reduce proptosis significantly, but have the disadvantage of cosmetic morbidity in terms of a cutaneous scar and a high incidence of postoperative complications. Recent advances in endoscopic sinus surgery have extended its applications beyond the nose to the orbit. Orbital decompression, drainage of subperiosteal abscess, optic nerve decompression, and orbital wall reconstruction are performed very safely and effectively by endoscopic intranasal surgery. Patients and methods Fifty-four patients indicated for endoscopic orbital decompression or reconstruction were divided according to the cause into five groups (20 infection, eight inflammatory, eight neoplastic, eight congenital, and 10 traumatic). Preoperative evaluations performed were history taking, physical examination, and computed tomography and MRI of orbit and paranasal sinuses. After creating an endoscopic wide middle meatal antrostomy dealing with the pathology causing extraconal orbital compression and in intraconal compression penetrate the lamina papyracea and periosteum until prolapsed fat fill the ethmoid sinus. Reconstruction was performed by removal of the fractured bone, extraocular muscle reposition with support using Foley's catheter in floor fracture and a silastic sheet with Merocel packing in medial wall fracture. Results There was significant proptosis reduction in all groups, especially in the infection group ( P P Conclusion Endoscopic nasal decompression of the orbit is a safe and effective approach for reducing proptosis and improving vision and ocular motility in cases of orbital compression, which include infection, inflammatory, neoplastic, congenital, and traumatic causes. Endoscopic intranasal reduction of the orbital floor with a Foley's catheter balloon and with a silastic sheet and Merocel packing of the medial orbital wall provided good functional results and definite advantages. Complications were limited.

Intratemporal Complications From Acute Otitis Media in Children: 17 Cases in two Years

BackgroundTo describe the clinical features of intratemporal complications of acute otitis media (AOM) in children, a retrospective study was carried out for 2 years. MethodsWe considered acute mastoiditis, presence of postauricular swelling, erythema and tenderness, and anteroinferior displacement of the auricle; labyrinthitis, presence of vestibular symptoms (spontaneous nystagmus and ataxia with or without vomiting; and facial nerve palsy, absence or decreased motility in hemiface.All children underwent otomicroscopy for evidence of coexistent or recent AOM. Cultures were obtained by tympanocentesis and myringotomy, drainage of subperiosteal abscess, or from granulation tissue during tympanomastoidectomy. ResultsFrom January 2008 to December 2009, 17 patients fulfilled the entry criteria. Median age: 54.2 months. Of the 17 cases, 30% were infants younger than 12 months and most were boys (70.6%).8/17 were receiving antimicrobial treatment. Diagnoses included 9/17 (52.9%) acute mastoiditis, 7/17 (41.2%) labyrinthitis, and 1/17 (5.9%) facial nerve palsy. Intracranial complications were present in 17.6%. All required intravenous antimicrobial treatment. Myringotomy was performed in 16/17, drainage of subperiosteal abscess in 3/17, and tympanomastoidectomy in 2/17. Bacteriology was positive in 9/17 cases, isolating Streptococcus pyogenes (S. pyogenes) in 44% of patients. Secuelaes: One unilateral sensorineural hearing loss. ConclusionsAcute mastoiditis is the most common complication. Labyrinthitis was diagnosed in 41.2% of cases. S. pyogenes was prevalent in these serious invasive infections in our area. Associated intracranial complications were present in 17.6% cases. Resolution of AOM complications required surgical procedures in all cases (myringotomy, drainage of subperiosteal abscess, or tympanomastoidectomy).

Diecisiete casos de complicaciones intratemporales de otitis media aguda en niños en dos años

BackgroundTo describe the clinical features of intratemporal complications of acute otitis media (AOM) in children, a retrospective study was carried out for two years. MethodsWe considered acute mastoiditis, presence of postauricular swelling, erythema and tenderness and anteroinferior displacement of the auricle; labyrinthitis, presence of vestibular symptoms (spontaneous nystagmus and ataxia with or without vomiting; and facial nerve palsy, absence or decreased motility in hemiface.All children underwent otomicroscopy for evidence of coexistent or recent AOM. Cultures were obtained by tympanocentesis and myringotomy, drainage of subperiosteal abscess or from granulation tissue during tympanomastoidectomy. ResultsFrom January 2008 to December 2009, 17 patients fulfilled the entry criteria. Median age: 54.2 months. Of the 17 cases, 30% were infants younger than twelve months and most were boys (70.6%).8/17 were receiving antimicrobial treatment. Diagnoses included 9/17 (52.9%) acute mastoiditis, 7/17 (41.2%) labyrinthitis and 1/17 (5.9%) facial nerve palsy. Intracranial complications were present in 17.6%. All required intravenous antimicrobial treatment. Myringotomy was performed in 16/17, drainage of subperiosteal abscess in 3/17 and tympanomastoidectomy in 2/17. Bacteriology was positive in 9/17 cases, isolating Streptococcus pyogenes (S. pyogenes) in 44% of patients. Secuelaes: One unilateral sensorineural hearing loss. ConclusionsAcute mastoiditis is the most common complication. Labyrinthitis was diagnosed in 41.2% of cases. S. pyogenes was prevalent in these serious invasive infections in our area. Associated intracranial complications were present in 17.6% cases. Resolution of AOM complications required surgical procedures in all cases (myringotomy, drainage of subperiosteal abscess or tympanomastoidectomy).

Orbital Cellulitis With Subperiosteal Abscess: Demographics and Management Outcomes

Infectious orbital cellulitis represents a serious threat to vision and, if untreated, poses significant morbidity risk. In this study, the authors attempt to further characterize the features of orbital cellulitis with subperiosteal abscess (SPA) and determine outcomes based on the type of surgical intervention employed. Data were obtained by retrospective chart review of all inpatient admissions for orbital inflammation/cellulitis from Sept 2005 to April 2010. Charts were reviewed for demographic information, radiographic and clinic evidence of orbital cellulitis, presence of SPA (defined by radiographic criteria), interventions taken (surgical and nonsurgical), presence of concurrent sinusitis, types of microbes present, and duration of hospital admission. Statistical analysis was performed using chi-square tests. A total of 97 patients were admitted with a diagnosis of orbital inflammation/cellulitis, of whom 49 patients had clinical and/or radiographic evidence of orbital cellulitis. Twenty-four patients had radiographic evidence of SPA. All patients with SPA had concurrent sinusitis, and 16 patients underwent initial surgical intervention. Nine patients had external transcaruncular/transcutaneous SPA drainage only, 6 had combined SPA and sinus drainage, and one had sinus drainage alone. Of those that underwent SPA-only drainage, 5 had SPA reaccumulation, while no reaccumulation occurred with combined SPA and sinus drainage. No reaccumulation occurred if the SPA was less than 2 cm in its greatest diameter. In this study, for those abscesses larger than 2 cm, combined sinus and SPA drainage was associated with improved treatment outcome, demonstrated by absence of abscess reaccumulation and shorter hospital stay. SPA-only drainage was more frequently associated with SPA reaccumulation.

Shifting trends: mastoiditis from a surgical to a medical disease

Objective The aim of this study is to review the outcome of pediatric patients suffering from acute mastoiditis treated conservatively and to correlate this to the evolution of our understanding of the shift in which mastoiditis has been transformed from a surgical to a medial disease. Methods We perfomed a retrospective review patient files hospitalized in our tertiary-care center between 2005–2008. We examined the data concerning the infection which included: presenting signs/symptoms, prior otologic history, treatment (including both surgical and conservative) prior to hospitalization and during hospitalization, computed tomography (CT), hospital duration, complications and overall outcome. This data was analyzed and compared between different patients who underwent different treatment strategies. Results Fifty-one patients were included in this retrospective review. Initially, forty-nine patients admitted to our hospital were treated conservatively. This treatment included intra-venous antibiotics, myringtomy and if needed subperiosteal abscess incision and drainage. Only 2 patients underwent CT scanning on admission. Further on, during hospitalization 4 additional patients underwent CT scanning due to continued fever or progression of local disease. All four CT scans showed no intra-cerebral complications, and so all continued with conservative treatment. Conclusion Most cases of acute mastoidits may be treated with a conservative therapy regime. This regime, in our opinion, should include three branches: the first intravenous antibiotic therapy using a broad spectrum antibiotic. The second is myringotomy and the third branch is incision and drainage of subperiosteal abscess when needed.

Indications for mastoidectomy in acute mastoiditis in children.

The objective of this study was to identify clinical features of acute mastoiditis in children that are indicative of the need for mastoidectomy. We performed a retrospective chart review of 40 children (20 male, 20 female) between 2 months and 12 years 9 months of age with a diagnosis of acute mastoiditis who were managed in our institution between July 1998 and June 2002. All patients received intravenous antibiotics; this was the only treatment in 14 patients (35%). Tympanostomy tubes were inserted in 22 patients, together with postauricular needle aspiration in 12 (30%), and incision and drainage of subperiosteal abscess in 10 (25%). Mastoidectomy was performed in 4 cases (10%), and cholesteatoma was found in 3. One other child was subsequently found to have cholesteatoma. We conclude that children who present with acute mastoiditis should undergo mastoidectomy if cholesteatoma is clinically suspected, or if extratemporal suppurative complications have occurred.

Endoscopic Drainage of Subperiosteal Abscess in Children: A Pilot Study

Subperiosteal abscess is a serious orbital complication of sinusitis that occurs predominantly in children. Infection may spread to the orbital site through a preexisting defect in the lamina papyracea or by means of a thrombophlebitic process. Although the traditional approach to treating a subperiosteal abscess has been drainage through an external incision, we treated this serious complication with functional endonasal sinus surgery. Ten pediatric patients with clinical and CT evidence of orbital subperiosteal abscess underwent endoscopic surgery at LeBonheur Children's Hospital in Memphis, Tenn., between July 1990 and June 1992. The four girls and six boys were between 3 and 12 years of age at the time of surgery. Despite 2 to 4 days of intravenous antibiotic therapy, their signs and symptoms progressed, and axial and coronal CT scans demonstrated orbital subperiosteal abscess. Seven patients had bilateral ethmoid and maxillary sinusitis, and the remaining three patients had unilateral ethmoiditis. Ophthalmologic assessments were performed for all patients immediately after hospital admission. The patients were started on regimens of high-dose intravenous cefuroxime sodium to subdue infections and pediatric decongestant nasal spray to facilitate drainage. All 10 patients with the confirmed diagnosis of subperiosteal abscess were treated with endoscopic surgery to drain the site of infection. All 10 patients improved significantly 12 to 24 hours after surgery and were discharged from the hospital to their homes 48 to 72 hours after surgery. Patients were continued on a regimen of broad-spectrum oral antibiotics and beclomethasone nasal spray for 2 weeks beyond the final examination. Follow-up endoscopic examinations were performed under general anesthesia in the operating room 2 to 3 weeks after surgery. No complications or adverse sequelae occurred. Our study appears to confirm that endoscopic drainage of subperiosteal abscess offers the patient an alternative to incisional surgery. The endoscopic approach prevents an external scar without increasing morbidity or length of hospitalization.