title: Medical and surgical management of subperiosteal orbital abscess secondary to acute sinusitis in children.
abstract: OBJECTIVE
  To evaluate the presentations and outcomes of pediatric subperiosteal orbital abscesses (SPOA) secondary to acute sinusitis.
  
  
  METHODS
  Case series
  
  
  METHODS
  Tertiary children's hospital.
  
  
  METHODS
  Forty-three admissions diagnosed with SPOA by clinical presentation and contrast enhanced computed tomography (CECT) were retrospectively reviewed.
  
  
  METHODS
  Clinical presentations, CECT dimensions, treatment, outcomes, and microbiology.
  
  
  RESULTS
  Eighteen/43 (42%) patients resolved their infection with medical management only, including five children older than nine. Twenty-five/43 (58%) children underwent surgical drainage. Purulence was identified in 22 of 25 surgical patients, and the most common organism was Streptococcus milleri (7 patients). Compared to 22 patients with drained purulence, the 18 patients with abscesses managed medically had significant differences for: chemosis in 2/18 (11.1%) versus 14/22 (63.6%, p=0.001), proptosis in 10/18 (55.6%) versus 20/22 (90.9%, p=0.025), elevated intraocular pressure (IOP) in 0/18 (0%) versus 11/22 (50%, p<0.001), severe restriction of extraocular movements in 1/18 (5.6%) versus 12/22 (54.5%, p=0.002), and length of stay (4.3 versus 5.8 days, p=0.038). The dimensions of medial SPOA managed medically were significantly smaller on CECT compared to surgically drained purulent SPOA: width (0.25 versus 1.46cm, p<0.001), height (0.73 versus 1.35cm, p=0.002), and length (1.1 versus 1.86cm, p=0.004). Persistent morbidities occurred in no patients managed medically and in 2/25 (8%) managed surgically.
  
  
  CONCLUSIONS
  Children with small medial SPOA without significant ocular signs may be managed medically with favorable outcomes. Proposed criteria for medical management of medial SPOA include: (1) normal vision, pupil, and retina; (2) no ophthalmoplegia; (3) IOP<20mmHg; (4) proptosis of 5mm or less; and (5) abscess width of 4mm or less. In contrast to prior series, older children with SPOA were managed successfully with medical therapy.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical Center, 1904 TC, 1500 E. Medical Center Dr., Ann Arbor, MI 48104, USA. lanceoxford@yahoo.com
authors.forename: Lance E
authors.initials: LE
authors.lastname: Oxford
authors.forename: John
authors.initials: J
authors.lastname: McClay
mesh_terms: D000038:Abscess / Q000000981:diagnostic imaging / Q000382:microbiology / Q000601:surgery*; D000208:Acute Disease; D000293:Adolescent; D001419:Bacteria / Q000302:isolation & purification; D002648:Child; D002675:Child, Preschool; D004322:Drainage; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009916:Orbital Diseases / Q000000981:diagnostic imaging / Q000382:microbiology / Q000601:surgery*; D010521:Periosteum / Q000000981:diagnostic imaging / Q000382:microbiology / Q000601:surgery*; D012852:Sinusitis / Q000150:complications* / Q000382:microbiology; D013492:Suppuration / Q000382:microbiology / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome