title: The role of osteitis of the lamina papyracea in the formation of subperiosteal orbital abscess in young children.
abstract: BACKGROUND
  Sub-periosteal orbital abscess (SPOA) typically presents as a collection of pus in the space between the periorbita and the lamina papyracea, adjacent to acute suppurative ethmoiditis. Osteitis of the lamina papyracea may lead to sequestrum formation, with progression of the infectious process to cause suppuration beneath the orbital periosteum.
  
  
  METHODS
  A case series of children with rhinosinusitis and SPOA admitted to our institute, from January 2005 to December 2011, was carried out. Included were children operated upon, in whom the lamina papyracea was submitted for histological examination, and in which bacteriologic studies were obtained.
  
  
  RESULTS
  Nine children with SPOA with a mean age of 5.03 years (range 1-12 years) were included in the present study. In five of them (55.5%), features of osteitis were noted histologically. No pathogens were observed histologically in the sections. Bacteriologic studies revealed Streptococcus viridans in four patients, and coagulase negative Staphylococcus in one.
  
  
  CONCLUSIONS
  SPOA in rhinosinusitis children was associated in our small cohort with high rate of lamina papyracea osteitis. The direct spread through the involved bone was raised as a possible pathophysiology of SPOA formation.
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, Assaf Harofeh Medical Center, Zerifin 70300, Israel; Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
authors.forename: Ephraim
authors.initials: E
authors.lastname: Eviatar
authors.affiliation: Department of Pathology, Assaf Harofeh Medical Center, Zerifin 70300, Israel; Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
authors.forename: Judith
authors.initials: J
authors.lastname: Sandbank
authors.affiliation: Department of Surgical Oncology, Peter MacCallum Cancer Institute, Melbourne, Australia.
authors.forename: Stephen
authors.initials: S
authors.lastname: Kleid
authors.affiliation: Department of Surgical Oncology, Peter MacCallum Cancer Institute, Melbourne, Australia. Electronic address: haim.ga@012.net.il.
authors.forename: Haim
authors.initials: H
authors.lastname: Gavriel
mesh_terms: D000038:Abscess / Q000209:etiology* / Q000601:surgery; D001850:Bone Diseases, Infectious / Q000150:complications*; D002648:Child; D002675:Child, Preschool; D015521:Ethmoid Sinusitis / Q000150:complications; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009915:Orbit; D010000:Osteitis / Q000150:complications*; D010521:Periosteum; D013203:Staphylococcal Infections / Q000150:complications*; D013290:Streptococcal Infections / Q000150:complications*; D013492:Suppuration / Q000209:etiology; D034363:Viridans Streptococci
keywords: Lamina papyracea; Orbital complications; Pathology; Subperiosteal orbital abscess