Orbital Subperiosteal Abscess Research Articles

Postoperative orbital fluid accumulation masquerading as subperiosteal orbital abscess: A case report and literature review

We herein present the case of a postoperative orbital fluid accumulation in a 1.5-year-old boy masquerading as subperiosteal orbital abscess (SPA). The patient was admitted to our hospital under the impression of orbital cellulitis with SPA. He subsequently underwent endoscopic sinus surgery and received external drainage for decompression. A significant amount of fetid odor abscess was drained from the subperiosteal space. However, a new episode of eyelid swelling was noted 1 week after the operation. Furthermore, a sinus computed tomography showed a very similar picture of the swelling compared with the preoperative image. Under the impression of recurrent SPA, a second operation was then performed. This time, however, only a small amount of granulated tissue and serosanguineous fluid was found. No microorganisms were cultured from this tissue/fluid, which ruled out any possible infection. It is thus a challenge to establish a differential diagnosis between postoperative fluid accumulation and SPA.

Medical versus surgical management of pediatric orbital subperiosteal abscesses

Medical versus surgical management of pediatric orbital subperiosteal abscesses

Drainage of subperiosteal orbital abscesses complicating pediatric ethmoiditis: Comparison between external and transnasal approaches

ObjectiveThe aim of the present study was to compare the external (EA), transnasal endoscopic (TEA), and combined (CA) external and transnasal approaches to drain orbital subperiosteal abscesses complicating pediatric ethmoiditis. MethodsThis retrospective study included 38 children consecutively operated in our center for an orbital subperiosteal abscess complicating an acute ethmoiditis. The distribution of surgical approaches used for our patients was the following: 12 TEA (32%), 21 EA (55%) and 5 CA (13%). All data were retrieved from patients’ clinical charts. ResultsNo surgical complication was observed in the present study regardless of the approach. The percentage of surgical failures requiring additional drainage was almost twice as high after TEA (failure rate: 25%) than after EA (failure rate 14.3%), but this difference was not significant. Parameters which significantly influenced the risk of failure of TEA were the length and width of the abscess. The duration of postoperative hospitalization was significantly lower in the TEA group (3.1 days) than in the EA one (5.4 days). There were no failures in the CA group. ConclusionsFailures of surgical drainage of orbital subperiosteal abscess complicating pediatric ethmoiditis are not rare and did not differ between external and transnasal endoscopic approaches in our study. The transnasal route is associated with a shorter postoperative duration of postoperative hospitalization. CA seems to be a viable surgical option combining the advantages of both endoscopic and external approaches.

Subperiosteal Orbital Abselere Yaklaşım: 2 Olgu ile Tartışma

Subperiosteal Orbital Abselere Yaklaşım: 2 Olgu ile Tartışma

Rabdomiosarcoma alveolar orbitario enmascarado por sinusitis etmoidal en un adulto de 25 años

Case reportA 25-year-old woman with right subacute sinusitis, complained about discomfort in her right eye. Clinical manifestations and computed tomography were suggestive of sub-periosteal orbital ethmoid wall abscess, for which the patient underwent urgent drainage. A solid tumor was found, with a positive biopsy for alveolar rhabdomyosarcoma. Complete remission and resolution of orbital symptoms were achieved with chemotherapy and radiation therapy. DiscussionAlveolar orbital rhabdomyosarcoma in adults is uncommon. Rhabdomyosarcoma has a high risk of spreading. It can simulate a sinusitis, as in our patient, early diagnosis and early treatment being especially important in these patients.

The Correlation of Microbiology Growth between Subperiosteal Orbital Abscess and Affected Sinuses in Young Children

Subperiosteal orbital abscess (SPOA) typically presents as a collection of pus in the space between the periorbit and the lamina papyracea adjacent to the infected paranasal sinuses. The aim of this study was to investigate the simultaneous microbiological growth from an SPOA and the paranasal sinuses in the same children. A retrospective study was performed on cultures obtained from involved sinuses and surgically drained abscesses in young children with SPOA from January 1992 to March 2009. Twenty-two children with a mean age of 5.9 years were included. Results of the microbiological studies were available from the sinuses of 17 children (77.2%) and from the SPOA in 18 children (81.8%). High rates of staphylococci bacteria and Streptococcus viridans were observed compared with lower-than-expected upper respiratory tract infection pathogens. Both groups showed scarce anaerobic and polymicrobial growth. In 13 children (59%), both sinus and abscess culture results were available with correlation found in only 4 (30.7%) of these children. In this study we report the results of bacteriological studies of nasal sinuses and SPOAs in young children, with a low rate of correlation between both sites and low rates of anaerobic growth, but high rates of staphylococcal growth in the SPOA cultures. These observations might be related to the trend toward conservative treatment in children.

Rapidly progressing subperiosteal orbital abscess: an unexpected complication of a group-A streptococcal pharyngitis in a healthy young patient

IntroductionComplications associated to group-A streptococcal pharyingitis include non-suppurative complications such as acute rheumatic fever and glomerulonephritis and suppurative complications such as peritonsillar or retropharyngeal abscess, sinusitis, mastoiditis, otitis media, meningitis, brain abscess, or thrombosis of the intracranial venous sinuses.Case presentationWe described a case of a 15-year-old patient with a history of acute pharyngodinia early followed by improvise fever and a progressive formation of a diffuse orbital edema, corneal hyperaemia, diplopia and severe decrease of visual acuity.The patient was surgically treated with functional endoscopic sinus surgery (FESS) after the response of a maxillofacial computed tomography scans that showed a pansinusitis complicated by a left orbital cellulites. Numerous colonies of Streptococcus pyogenes were found in the samples of pus and an antibiotic therapy with meropenem was initiated on the basis of the sensitivity test to antibiotics. The patient was finally discharged with diagnosis of left orbital cellulites with periorbital abscess, endophtalmitis and acute pansinusitis as a consequence of streptococcal pharyngitis.ConclusionThe case highlights the possible unusual complication of a group-A streptococcal pharyingitis in a immunocompetent child and the needing of a prompt surgical and medical approach toward the maxillofacial complications associated to the infection.

Approaches to subperiosteal orbital abscesses

The purpose of this paper is to evaluate the epidemiology, clinical features, management and complications of subperiosteal orbital abscesses (SPOA)-a serious complication of rhinosinusitis. Retrospective data of 36 patients with SPOA secondary to acute rhinosinusitis from January 1998 to December 2011 were evaluated. Patients were analyzed in terms of age, gender, clinical features, CT findings, surgical procedures, microbiology, and complications. Twenty-three males and 13 females aged from 3 to 76 were evaluated. Nine patients-seven of which were under the age of 10-with small medial SPOA were treated only with medical management. Of the 13 with medial SPOA, transnasal endoscopic approach was performed for 10 and external approach for 3 to drain the abscess. As for the 12 patients with superior SPOA, 8 were treated via combined approach and 4 via external approach. The most common microorganisms were streptococci in children and anaerobes in adults. Total loss of vision developed in two adults with diabetes mellitus (DM). One patient with superior SPOA died due to frontal lobe abscess. Young children with small medial SPOA without significant ocular signs may successfully be managed medically. Surgical drainage is indicated for nonmedial abscesses, large medial abscesses with severe visual loss and with insufficient response to medical management. The risk of blindness from SPOA is higher in patients with DM.

Orbital Complication of a Paranasal Sinus Actinomycosis

Objective: 1) Describe the first reported case of paranasal sinus actinomycosis associated with an orbital complication. 2) Describe other unusual features of the case: the occurrence of the infection in an immunocompetent pregnant patient, the involvement of the ethmoid sinus, the safety of a surgical treatment in a 15-week pregnant patient. Method: Case report of a 25-year-old woman, 15 weeks pregnant. Disease studied: Ethmoid sinus actinomycosis complicated by an subperiosteal orbital abscess. Setting: Tertiary referral university hospital. Intervention: Intravenous antibiotic therapy associated with a surgical treatment under general anesthesia. Outcome measurement: Safety and efficacy of the treatment. Results: The patient was admitted for treatment of the complicated rhinosinusitis. She immediately started intravenous antibiotic therapy with amoxicillin and clavulanic acid and a surgical drainage under general anesthesia was indicated. Risks for the patient and for the fetus were discussed and the informed consent was obtained for the anesthetic and for the surgical procedures. A combined external and transnasal endoscopic approach was performed to treat the infection. Actinomyces meyeri was isolated. The patient improved and was discharged after 14 days of medical treatment. Eight months after surgery the patient and her newborn are both well and no sequelae were registered. Conclusion: Actinomycosis of the paranasal sinus can involve primarily the ethmoid sinus, do not have a history of dental procedures or trauma, and result in orbital complications. Standard medical and surgical therapies for complicated rhinosinusitis are safe and effective, even in a pregnant patient.

Paranasal sinus infection causing orbital subperiosteal abscess: surgical management of this devastating entity

Orbital infection is an uncommon devastating infection and is usually a complication of paranasal sinus infection. Without appropriate treatment, orbital infection may lead to serious complications, even death. Prompt treatment is mandatory to avoid visual loss or intracranial complications. The literature shows that initially, intravenous antibiotics should be administered, and after 48h, if no improvement appears, the affected orbit and the sinuses must be surgically drained. The authors describe two cases of orbital cellulitis with a brief literature review. The authors describe two cases of orbital abscess caused by paranasal sinus infection. In case 1, the patient presented a decreased visual acuity associated with ophthalmoplegia of the right eye. In case 2, the patient presented a decreased visual acuity. Thus, administration of intravenous antibiotic combined with surgical drainage was performed. After surgical procedure, eye movements were normalized in case 1, and in both patients, the visual acuity returned to normal parameters. The authors recommend early surgical drainage with parenteral antibiotic administration and careful postoperative observations by monitoring the signs and symptoms of the orbital complaint.

A Case of Child Facial Orbital Subperiosteal Abscess Arising from Lacrimal Sac Infection

A Case of Child Facial Orbital Subperiosteal Abscess Arising from Lacrimal Sac Infection

Dimension of Subperiosteal Orbital Abscess as an Indication for Surgical Management in Children

Eyelid edema in children is one of the signs of orbital complications secondary to acute rhinosinusitis, and identifying abscess formation is crucial for management decision. The objective of this study is to determine whether there are different computed tomography scan abscess dimensions and volumes in children requiring medical versus surgical management for subperiosteal orbital abscess (SPOA). Case series with chart review. The study was conducted at Assaf Harofeh Medical Center. Clinical and radiological parameters of 95 children admitted with eyelid edema between January 2005 and December 2007 were studied. Of 95 cases of orbital cellulitis, a total of 48 children with sinogenic orbital complications with a mean (SD) age of 4.03 (3.46) years were included. No significant difference was found between the surgically and medically treated SPOA groups regarding the use of preadmission antibiotic and clinical presentation. Statistically significant larger abscesses in the surgically treated group were noted (mean volume 1.389 vs 0.486 mL in the conservatively treated group; P = .013) and a longer mean anterior-posterior and medial-lateral dimension (P = .001 and .017, respectively). Children presenting with significant or progressing ocular findings or failure to improve after 48 hours of medical therapy, together with an abscess volume of more than 0.5 mL, a length greater than 17 mm, and a width greater than 4.5 mm, should be strongly considered to have surgical drainage.

The Pott’s puffy tumor: a dangerous sign for intracranial complications

The Pott's puffy tumor is a subperiosteal abscess of the frontal bone associated with osteomyelitis. The purpose of this article is to alert the physician to the severe complications of this entity. The records of six patients were reviewed retrospectively. There were four adults and two adolescents. Nasal endoscopy showed edematous, polypoid mucosa in middle meatus in three and nasal polyps in the rest. At initial admission, two had orbital subperiosteal abscess, but normal cranial CT findings. During hospitalization, three experienced frontal lobe abscess and one frontal cerebritis. Endoscopic sinus surgery was performed in all with external drainage of Pott's puffy tumor in addition to antibiotherapy. Three patients underwent craniotomy/craniectomy for removal of frontal lobe abscesses. One patient with frontal lobe abscess died. Pott's puffy tumor may result in potentially dangerous intracranial complications. Early diagnosis and treatment are essential to reduce morbidity and mortality.

골미전두동염의 합병증으로 발생한 상부 안와 골막하 농양 1예

Subperiosteal orbital abscess is one of common complications of sinusitis and can lead to exopthalmosis, diplopia or visual loss if not treated. Usually this abscess is occurred medial or inferior side of the orbital compartment due to the ethmoid or maxillary sinusitis, while orbital abscess which is located superiorly of the orbit is rare. We report our experience with subperiosteal abscess, located superiorly to the orbital compartments with orbital roof erosion, which is successfully treated by endoscopic transnasal and external approach. (J Clinical Otolaryngol 2011;22:102–105)

Acute Rhinosinusitis—Related Orbital Infection in Pediatric Patients: A Retrospective Analysis

Periorbital infection frequently originates from acute rhinosinusitis in children. We tried to find the characteristics of pediatric patients who are likely to develop subperiosteal orbital abscesses and to need emergency surgery for acute orbital swelling. In an observational retrospective cohort study, we reviewed 64 children less than 18 years of age who visited emergency rooms for periorbital swelling and were hospitalized with a diagnosis of periorbital cellulitis and subperiosteal orbital abscess between 1996 and 2007 at Chang Gung Memorial Hospital. The presence of periorbital abscess was diagnosed radiographically, and all of the patients had concomitant sinusitis that was proved by computed tomographic scan. The mean age of the patients was 6.95 years, and 42 (65.63%) were male (male-to-female ratio, 1.91). Thirty patients (46.88%) had surgical drainage, and 34 (53.13%) received antibiotic therapy only. The factors associated on bivariate analysis with abscess formation were age of 6 years or less (p = 0.023), proptosis (p = 0.012), fever (p < 0.001), and a white blood cell count of more than 11,100 cells per microliter (p = 0.004). On multivariate analysis, fever and proptosis were independent factors that predicted abscess formation. In patients who underwent surgical drainage, the most frequently cultured microbes were Staphylococcus aureus, Streptococcus viridans, and coagulase-negative staphylococci, and 29% of our patients had polymicrobial pus cultures. The most important factor in predicting the failure of antibiotic treatment of sinusitis-related periorbital infections is abscess formation. Patients with fever and proptosis are prone to develop subperiosteal orbital abscesses.

Management of Superiorly Based Subperiosteal Orbital Abscess

Subperiosteal orbital abscess (SPOA) is an uncommon but serious consequence of sinusitis, especially in the pediatric population. Historically, medical and surgical arms have been utilized in the treatment of SPOA. Below is a case report of a 14 year-old-boy with recalcitrant, superiorly based SPOA followed by a literature search and discussion.

Management of Orbital Subperiosteal Abscess

To discuss the role of surgical intervention in subperiosteal orbital abscess (SPOA) using a retrospective medical chart review. A retrospective medical chart review of subjects who were diagnosed and surgically treated for SPOA between 2002 and 2009. Ten patients were identified (8 males and 2 females). All SPOAs were unilateral. Of 10 SPOAs, 7 were on the left and 3 were on the right. Six of these were medially located abscesses, whereas 4 were superior abscesses. Of the 6 medially located abscesses, 4 were treated with transnasal endoscopy (TNE). External (E) drainage was needed in 2 of the medially located abscesses. In one of these abscesses, the surgeon was forced to drain the abscess with TNE and turned to E drainage. In the other, TNE was performed first. Despite medical therapy and TNE, patients' orbital symptoms did not resolve. A second operation was performed with E drainage. Four of the superiorly based SPOAs were treated with combined E-TNE approach. External drainage of the SPOA is needed on 6 (60%) of the patients in this study. Superiorly located abscesses were initially treated with E drainage, and then functional endoscopic sinus surgery was performed to treat the affected sinuses. Transnasal endoscopic management failed in 2 patients, hence E drainage was needed. The characteristics of the patients are presented and discussed in view of a surgical approach.

Management implications of diagnosing orbital abscess as subperiosteal orbital abscess

Orbital complications of rhinosinusitis can be life-threatening. Accurate diagnosis by computerized tomography (CT) scanning, immediate administration of intravenous antibiotics and surgical drainage are the recommended management strategy. Faulty diagnosis by CT scan may lead to visual deterioration, intracranial complications and even fatality. The purpose of this study is to increase the awareness of the possibility of misdiagnosing orbital abscess (OA) as subperiosteal orbital abscess (SPOA) and propose a novel surgical technique to overcome this surgical circumstance. Three cases of OA and 29 of SPOA cases that were surgically managed between 1998 and 2008 were retrospectively reviewed. Three cases of OA diagnosed by CT scan as SPOA were primarily medically treated by intravenous antibiotics. Once the therapeutic management failed to resolve the condition, endonasal endoscopic surgery (EES) was carried out, upon which the diagnosis of OA was made and drainage successfully achieved. Whenever SPOA is diagnosed by CT scan and no purulent discharge is evidenced after removal of the lamina papyracea, OA should be suspected and incisions along the orbital periosteum should be made to release the pus from the orbit. The EES approach in cases of OS and SPOA can confirm an accurate diagnosis.

Is pyogenic ethmoidal osteitis the cause of complicated rhinosinusitis with subperiosteal orbital abscess?

Multiple theories were described concerning the pathogenesis of orbital infection in rhinosinusitis, but no theory was proved. Understanding the cause of complication can allow its proper management. We speculate that subperiosteal orbital abscess (SPOA) secondary to rhinosinusitis is similar to subperiosteal abscess associated with osteomyelitis of bone all over the body. The objective was to evaluate bony changes of the ethmoidal sinuses in complicated rhinosinusitis patients with SPOA. This prospective controlled study was performed on eight patients undergoing endoscopic sinus surgery drainage for rhinosinusitis complicated with SPOA. Age, radiographic bony characteristics, and histopathological findings were all documented. Ethmoidal bone specimens were examined and assessed histopathologically. Purulence of SPOA was collected and sent for cultures. The authors evaluated normal ethmoidal bone specimens taken endoscopically from the medial wall of obstructing concha bullosa in ten control patients. The analysis revealed CT and histopathologic changes consistent with high grades of ethmoidal bone pyogenic osteitic changes. Coagulase-positive staphylococci were the predominant cultured bacteria (62.5%) in SPOA. These findings suggest that orbital subperiosteal abscess in rhinosinusitis patients is attributed to diffuse higher grades of ethmoidal sinus bony pyogenic osteitis. Staphylococcus aureus is the most commonly involved cultured bacteria. Bony osteitis in rhinosinusitis patients with SPOA is similar clinically and histopathologically in its character and behavior to osteomyelitis of bone all over the body with associated subperiosteal abscess.

Clival Inflammation With Cavernous Sinus Thrombophlebitis and Orbital Subperiosteal Abscess -Case Report-

A 64-year-old woman presented with a very rare case of three infectious lesions, cavernous sinus thrombophlebitis, clival inflammation, and orbital subperiosteal abscess (SPA), manifesting as abducens palsy. An isolated non-specific mass in upper clivus was initially suspected to be derived from paranasal sinusitis. The clival lesion was approached by an endonasal transsphenoidal route and diagnosed as inflammation. However, progressive enlargement of an orbital mass was recognized, with eyelid erythema and swelling. Magnetic resonance imaging showed massive paranasal sinusitis and an intra-orbital mass, which was proved to be an orbital SPA by open surgery. Cavernous sinus thrombophlebitis might have been caused by primary paranasal sinusitis, and the origin of orbital cellulitis was suspected to be cavernous sinusitis based on the preoperative radiological findings. These unusual lesions should be kept in mind as one of the differential diagnoses.