Management of pediatric orbital cellulitis in patients with radiographic findings of subperiosteal abscess

Abstract

The majority of small SPAs as diagnosed on CT scans in younger children can be successfully treated medically. Surgery, however, should be considered for a worsening clinical examination. Our findings confirm those of previous reports on this clinical entity.

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

“…In an extensive case study that involved 450 children, Ryan et al (8) assessed acute cases with orbital complications; 50% of children were diagnosed with periorbital cellulitis and 35% with orbital cellulitis. In our study, on the other hand, 82% (9 cases) of the cases were diagnosed with periorbital cellulitis.…”

“…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).…”

“…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.…”

“…A potential danger in visual functions constitutes an immediate indication for surgery with enTurk Arch Otolaryngol 2014; 52: 131-8 donasal or external approach. Vision loss results from abscess compression; increase in intraorbital pressure due to cellulitis; septic optic neuritis; embolic and thrombotic lesions in vessels supplying optic nerve, retina, or choroid; purulent inflammation of the optic nerve; and corneal ulceration (7)(8)(9)(10). Patients should be evaluated ophthalmologically and should be given hourly visual inspection, if necessary.…”