Dimension of subperiosteal orbital abscess as an indication for surgical management in children

Abstract

Objective: 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).

Study design: Case series with chart review.

Setting: The study was conducted at Assaf Harofeh Medical Center.

Subjects and methods: Clinical and radiological parameters of 95 children admitted with eyelid edema between January 2005 and December 2007 were studied.

Results: 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).

Conclusion: 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.