Management of pediatric orbital cellulitis and abscess

Abstract

Periorbital complications of sinusitis in pediatric patients often respond to medical therapy but may require surgical intervention to prevent serious complications. Continuous in-house evaluation of patients is necessary to observe for progression of symptoms and to optimize outcome.

Endoscopic Drainage of Orbital Subperiosteal Hematoma Secondary to Acute Rhinosinusitis in a Child

“…In children, the periosteum at the medial orbital wall is loosely attached to the underlying lamina papyracea (Reid 2004). A recent review of cases of pediatric subperiosteal abscess suggested that immediate surgical intervention is not always the best treatment option (Bedwell and Bauman 2011;Bedwell and Choi 2013). Patients presenting with advanced ophthalmologic findings (impaired visual acuity, elevated intraocular pressure, ophthalmoplegia, proptosis ≥ 5 mm) or with large abscesses (width > 10 mm) are best treated surgically.…”

“…Conventionally, emergency endoscopic sinus surgery combined with intravenous antibiotics is the first choice for the treatment of suspected abscess (Eviatar et al 2008;Sultész et al 2009;Kinis et al 2013). However, immediate surgical intervention may not always be necessary for subperiosteal abscess (Bedwell and Bauman 2011;Bedwell and Choi 2013). Orbital subperiosteal hematoma is rare and occurs most often after trauma (Dobben et al 1998).…”

Orbital Complications of Acute Sinusitis: Evaluation, Management, and Results

“…MRI is also important in the assessment of complications due to sinus infections such as cavernous sinus thrombosis. For the diagnosis, follow-up of treatment, and possible complications of acute rhinosinusitis, as well as for surgical planning of the cases considered, PNSCT is a frequently used imaging method with high sensitivity (7)(8)(9)(10)(11)(12). In particular, the location and extent of infection during acute rhinosinusitis is important.…”

“…Also, in the literature, the medical treatment for cases of suspected orbital complications of acute sinusitis is ampicillinsulbactam, cefuroxime, ceftriaxone, cefotaxime, or clindamycin and the necessity of the medical treatment administration for 4-8 weeks is highlighted (7)(8)(9)(10)(11)(12)(13)(14). In our study, for preseptal cellulitis, we administered intravenous (IV ) 4×1.5 g of ampicillin-sulbactam (adult dose 3-4×1.5-3 g/day, pediatric dose 150 mg/kg [50 mg sulbactam and ampicillin] in children); for subperiosteal abscess, a combination of IV 4×1.5 g ampicillinsulbactam and ornidazole (adult dose 2×500 mg/day, pediatric dose 2 doses of 25 mg/kg/day); and for orbital abscess, IV ceftriaxone 2×1 g (adult dose 1-2 g/day, pediatric dose 50-75 mg/kg/day) -ornidazole 2×500 mg (adult dose 2×500 mg/ day, pediatric dose 2 doses of 25 mg/kg/day).…”

“…According to this, the foundation of the algorithm is related to the prevalence of infection on PBSCT, clinical rhinosinusitis characteristics and the response to medical treatment of the case, and the size of the possible abscess (abscess <10 mm) (8)(9)(10)(11)(12)(13)(14).…”