Transnasal endoscopic drainage of a medial subperiosteal orbital abscess

Abstract

The exact incidence of orbital complications due to sinusitis in children is unknown. However, a medial subperiosteal orbital abscess is the most common serious complication to occur. Surgical intervention is mandatory whenever antibiotic treatment fails. Most authors prefer open surgical procedures such as external ethmoidectomy, while others recommend transnasal endoscopic drainage as the first attempt at sinus decompression. Five out of 12 children with proven subperiosteal orbital abscess and sinusitis on computed tomographic scans failed antibiotic treatment and required surgical drainage. Transnasal endoscopic drainage of the abscess was performed on four patients, while one child underwent external ethmoidectomy. Our experience with endoscopic surgery in these four cases is discussed, along with a brief review of the advantage of this procedure over external surgery.

Clinical guidelines for the management of craniofacial fibrous dysplasia

“…Though there is very little literature on the effectiveness of sinus surgery in patients with FD sinus disease and sinus obliteration, if surgery is indicated, we recommend waiting until the adjacent FD is quiescent and the patient is at least in the late teens and skeletally mature to minimize the possibility of regrowth and necessity for re-treatment. Endoscopic sinus surgery with and without image-guided systems has become a popular approach [56-58], although it may be necessary to combine endoscopy with a traditional external approach [59,60]. The extent of resection should be based on the location of the pathological bone and its proximity to important sinus structures, as radical or complete resection may not be necessary or possible.…”

A case of retroorbital subperiosteal hematoma and frontal extradural abscess

“…Recently, combinations of vancomycinceftazidime and cefotaxime-amikacin have been found very effective [13]. Any deterioration in vision and pupillary response and also failure to response to antibiotics require surgical drainage [7,[9][10][11]13,14]. As recommended in limited number of previously reported cases, in our patient also visual deterioration and nonresponse to antibiotics in presence of CT scan picture of a retroorbital mass justified surgical exploration and evacuation of hematoma.…”

“…Subperiosteal hematoma of the orbit is a rare but well-recognized entity and is usually caused by trauma [1]. Subperiosteal hematoma and frontal extradural abscess manifesting as sudden onset of orbital pain, and exophthalmos is extremely rare and only few case reports are there in world literature [1][2][3][4][5][6][7][8][9][10][11][12][13][14]. We describe a case of subperiosteal hematoma in a child and review the relevant literature.…”

Bilateral Orbital Complications of Pediatric Rhinosinusitis

“…2,9 Although the incidence of complications from rhinosinusitis has decreased since the advent of antibiotics, 10 the risk of orbital involvement remains significant. 4,7,11 Upper respiratory infections are common in children; therefore, complications of rhinosinusitis remain a major cause of orbital inflammation and visual impairment. 5 Orbital complications arise from rhinosinusitis that spreads from the ethmoid sinus to the subperiosteal space underlying the lamina papyracea.…”

“…In each of the 3 children, the orbital complications on one side were more problematic (left side, 2 children; right side, 1 child).Previous studies have shown that the orbital complications of rhinosinusitis do not affect either the left or the right side preferentially. 11,13 Mann et al 13 studied 26 children who had orbital complications of rhinosinusitis. Surgery failed initially in 6 (23%) of the 26 children, and they required revision procedures.…”