Approaches to subperiosteal orbital abscesses

Ketenci, İbrahim; Ünlü, Yaşar; Vural, Alperen; Doğan, Hakkı; Şahin, Mehmet İlhan; Tuncer, Erkun

doi:10.1007/s00405-012-2198-x

Cited by 35 publications

(35 citation statements)

References 49 publications

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“…The orbital complications, as a result of the spread of infection from the sinuses to adjacent tissues, are the most frequent complications, which accounts for about 80% of all complications. If the treatment is not correct and in time, orbital complications could progress rapidly, leading to optic neuritis, cavernous sinus thrombophlebitis or life-threatening intracranial complications (2,3). In order to explore the correct treatment of orbital complications secondary to acute rhinosinusitis, a retrospective analysis of 31 pediatric patients with orbital complications was made in our hospital.…”

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confidence: 99%

Treatment of Orbital Complications Following Acute Rhinosinusitis in Children

Wan¹,

Shi²,

Wang³

2016

Balkan Med J

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Background:The orbital complications account for about 80% of all complications secondary to acute rhinosinusitis. If the treatment is not correct and in time, orbital complications could progress rapidly, leading to optic neuritis, cavernous sinus thrombophlebitis or life-threatening intracranial complications. Aims: To evaluate the therapeutic efficacy of conservative therapy for the patients with orbital cellulitis and endoscopic sinus surgery (ESS) performed on patients with subperiosteal abscess (SPA) secondary to acute rhinosinusitis in children. Study Design: Retrospective cross-sectional study. Methods: The retrospective study included 31 pediatric patients with orbital complications secondary to acute rhinosinusitis. In all cases, intensive treatment was initiated with a combination of oral or intravenous antibiotics, glucocorticoid and gelomyrtol forte after admission. ESS was performed if an improvement in the condition of patients did not occur after 48 hours. However, the patients with orbital SPA, motility disorders of eyeball or decreased vision received ESS immediately within 24 hours. Results: Sixteen patients were cured by conservative therapy and 15 patients by ESS. All of the signs and symptoms disappeared after conservative therapy or ESS. There were no recurrences within the follow-up period of 1 to 8 years. Conclusion: Conservative therapy is an effective method for patients with inflammatory edema and most cases of orbital cellulitis in children. SPA can be cured by ESS.

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confidence: 99%

Treatment of Orbital Complications Following Acute Rhinosinusitis in Children

Wan¹,

Shi²,

Wang³

2016

Balkan Med J

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“…The advent of the Pneumococcal and H. influenzae type b (HiB) vaccinations have reduced the incidence of streptococci 15,16 and HiB; however, this has correlated with an increased incidence of S. aureus as well as methicillin‐resistant S. aureus (MRSA), 15‐17 not only in SPAs but also in rhinosinusitis 17 . It is also thought that this has been associated with an increase in cases of S. milleri – S. anginosus group and S. pyogenes 13,16,18,19 . Anaerobic organisms or oropharyngeal flora are also commonly detected.…”

Section: Discussionmentioning

confidence: 99%

The management of periorbital cellulitis secondary to sinonasal infection: a multicenter prospective study in the United Kingdom

Mahalingam

Hone

Lloyd

et al. 2020

Int Forum Allergy Rhinol

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Background: Periorbital cellulitis is a potential sightthreatening complication of sinusitis. The majority of patients improve with medical management. Previous studies have suggested significant variations in practice and lack of evidence regarding the optimal management of this condition. Methods:A prospective study was conducted over a 12month period at 8 centers in the United Kingdom assessing the management of patients requiring inpatient treatment for periorbital cellulitis secondary to sinonasal infections. Results:A total of 143 patients were recruited, of whom 40 were excluded. Of the remaining 103 patients, 5 (4.9%) were diagnosed with neurosurgical complications. This resulted in 98 patients admi ed with periorbital cellulitis secondary to an upper respiratory tract infection/sinusitis. A total of 72 were children, of whom 12 (16.7%) required surgical intervention; and of 26 adults, 5 (19.2%) required surgery: the most common antimicrobial regimes administered were intravenous ce riaxone (with or without metronidazole), and co-amoxiclav. The use of both ce riaxone and metronidazole from admission was associated with the shortest duration of inpatient stay (3.8 days) in com-parison to ce riaxone alone (5.8 days) or co-amoxiclav (4.5 days) and a reduction in number of patients requiring surgical intervention. There was also an association between the early use of intranasal decongestants and steroids and reduction in requirement for surgical intervention. Conclusion:For a condition where swab and blood cultures are o en negative, this study supports the use of ce riaxone in combination with metronidazole. The administration of intranasal decongestants and corticosteroids correlated with a smaller percentage of those progressing to surgery in those with and without periorbital abscesses. C 2020 ARS-AAOA, LLC.

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“…The mean interval between admission to ENT unit and surgical intervention was 1.26 days.The symptoms at presentation included fever in 73.7% (14), periorbital swelling in 90% (16), eye pain in 63.2% (12), history of upper respiratory tract infection in 68.4% (13) and epiphora in 63.2% (12). Visual loss or a relative afferent papillary defect was not present in any of the patients.Signs included chemosis in 68.4% (13), proptosis in 57.9% (11) and ophthalmoplegia in 42.1% (8).Chemosis was found in 62% of the patients with intra-orbital abscesses, showing a statistically significant association. Ophthalmoplegia was seen in 37% of the patients with intra-orbital abscesses, but did not show a statistically significant association.…”

Section: Figure 2-unit Of First Contactmentioning

confidence: 98%

“…Various studies have suggested criteria for conservative management including age less than 9 years, medially located small subperiosteal abscess (less than 10mm), no suspicion for anaerobic infection or dental origin, no suspicion of frontal sinusitis, no chronic sinusitis and normal vision, pupil & retina, no ophthalmoplegia, intraocular pressure < 20mmhg and proptosis of less 5mm [12,13,14,15] .…”

Section: Organisms Culturedmentioning

confidence: 99%

“…In the present study all patients had radiological subperiosteal and intraorbital abscess formation with suspicion of anaerobic infection in one patients due to presence of intraorbital gas. The size of the abscesses could not be identified owing to absence of retrospective data [12,13,14,15,16] . In the present study 55.5% had features of frontal sinusitis on Computed Tomography, but these values may be misleading as the frontal sinuses are often underdeveloped in the paediatric population.…”

Section: Organisms Culturedmentioning

confidence: 99%

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Orbital complications of acute rhinosinusitis: a study on clinical profile, surgical management and outcome

Rosa

Warnasuriya

Kirihene

2018

Ceylon J Otolaryngology

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Objectives 1. Evaluate the clinical signs and their correlation to Computed Tomography(CT) findings 2. Assess the correlation between CT and intra-operative findings. 3. To identify implicated microorganisms. 4. Evaluate the current practice in surgical management. Methodology A descriptive retrospective study conducted at Lady Ridgeway Hospital (LRH) on 19 patients who underwent endoscopic sinus surgery, drainage of pus and orbital decompression for radiologically suspected orbital complications of acute rhinosinusitis from 01/01/2015 to 31/12/2018. Results Clinical features were fever (73.7%), peri-orbital swelling (100%), chemosis(68.4%), proptosis(57.9%) and ophthalmoplegia(42.1%). Chemosis and ophthalmoplegia were found in 62% and 37% of the patients with intra-orbital abscesses, with only chemosis showing a statistically significant association. CT was suggestive of subperiosteal abscess or inflammation in all. Intra-operatively abscesses were found in 16 (84.2%). Of these 6 had both subperiosteal and intra-orbital abscesses. Eight had subperiosteal abscesses. Two had only intra-orbital abscesses. The CT scan failed to predict the presence of abscess within the orbital fat in 3 out of 8. The positive predictive value was 89.4% for CT to detect orbital abscesses. An Intra-operative bony defect was noted in 15.8%. The mean surgery duration was 2.04 hours. Cultures revealed MRSA(21.1%), MSSA(15.8%), Pseudomonas(10.5%), mixed growth(10.6%) and Streptococcus viridans(5.3%). Conclusion The commonest presentations were peri-orbital swelling, fever, chemosis. MRSA and pseudomonas being the commonest organism, the appropriate empirical therapy needs further discussion. Endoscopic surgery is safe, reliable and cosmetic. As patients with intra-orbital abscesses may not be detected clinically or radiologically, we recommend routine incision of the orbital periosteum for suspected orbital complications of acute rhinosinusitis when undergoing endoscopic surgery.

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Approaches to subperiosteal orbital abscesses

Cited by 35 publications

References 49 publications

Treatment of Orbital Complications Following Acute Rhinosinusitis in Children

Treatment of Orbital Complications Following Acute Rhinosinusitis in Children

The management of periorbital cellulitis secondary to sinonasal infection: a multicenter prospective study in the United Kingdom

Orbital complications of acute rhinosinusitis: a study on clinical profile, surgical management and outcome

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