title: Subperiosteal orbital abscess: volumetric criteria for surgical drainage.
abstract: OBJECTIVE
  To investigate predictive factors of surgical management of subperiosteal orbital abscess in children.
  
  
  METHODS
  A retrospective monocentric study was conducted between 2000 and 2011 with children hospitalized for acute pediatric orbital cellulitis (APOC). Clinical, biological and radiological data as well as medical and surgical management were collected and analyzed. All patients received intravenous antibiotics and underwent a CT-scan. Orbit and subperiosteal intraorbital abscess dimensions were measured on axial and coronal planes and the abscess volume was calculated using a spheroid model.
  
  
  RESULTS
  Eighty-three children with APOC (mean age: 4.5 years) were included, 53 were boys (63.9%). Thirty-two children (38.6%) presented with a subperiosteal orbital abscess. Mean abscess volume was 570mm(3) and mean exophthalmos was 4.7mm. Twenty patients were treated surgically, 11 of which by an endoscopic approach. A positive correlation was observed between the volume of the abscess or exophthalmos and surgical drainage: 57.9% of patients underwent surgery when exophthalmos was >4mm, 29.4% between 2 and 4mm, and none when <2mm. All patients with an abscess volume >500mm(3) or >5% of orbital volume were operated on whereas only 30% or 39% of patients, respectively, in case of smaller volumes (P<0.05).
  
  
  CONCLUSIONS
  Surgery for subperiosteal orbital abscess is usually performed in case of visual complications or unfavorable medical outcome. The importance of the exophthalmos and the volume of the abscess measured on the CT-scan are predictive factors of surgery in children with subperiosteal orbital abscess without visual complications.
authors.affiliation: Pediatric otorhinolaryngology department, Robert Debré Hospital, APHP, Université Paris 7 Denis Diderot, Sorbonne Paris Cité, Paris, France.
authors.forename: Florian
authors.initials: F
authors.lastname: Tabarino
authors.affiliation: Pediatric radiology department, Robert Debré Hospital, APHP, Université Paris 7 Denis Diderot, Sorbonne Paris Cité, Paris, France; University Paris Diderot, Sorbonne Paris Cité, UMRS 1141, F-75019 Paris, France; Inserm, U1141, F-75019 Paris, France.
authors.forename: Monique
authors.initials: M
authors.lastname: Elmaleh-Bergès
authors.affiliation: Pediatric otorhinolaryngology department, Robert Debré Hospital, APHP, Université Paris 7 Denis Diderot, Sorbonne Paris Cité, Paris, France.
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Quesnel
authors.affiliation: Pediatrics department, Robert Debré Hospital, APHP, Université Paris 7 Denis Diderot, Sorbonne Paris Cité, Paris, France.
authors.forename: Mathie
authors.initials: M
authors.lastname: Lorrot
authors.affiliation: Pediatric otorhinolaryngology department, Robert Debré Hospital, APHP, Université Paris 7 Denis Diderot, Sorbonne Paris Cité, Paris, France; University Paris Diderot, Sorbonne Paris Cité, UMRS 1141, F-75019 Paris, France; Inserm, U1141, F-75019 Paris, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Van Den Abbeele
authors.affiliation: Pediatric otorhinolaryngology department, Robert Debré Hospital, APHP, Université Paris 7 Denis Diderot, Sorbonne Paris Cité, Paris, France; University Paris Diderot, Sorbonne Paris Cité, UMRS 1141, F-75019 Paris, France; Inserm, U1141, F-75019 Paris, France. Electronic address: natacha.teissier@rdb.aphp.fr.
authors.forename: Natacha
authors.initials: N
authors.lastname: Teissier
mesh_terms: D000038:Abscess / Q000175:diagnosis* / Q000601:surgery*; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D004322:Drainage; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D054517:Orbital Cellulitis / Q000175:diagnosis* / Q000601:surgery*; D018579:Patient Selection; D011379:Prognosis; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
chemical_list: D000900:Anti-Bacterial Agents
keywords: Ocular complications; Pediatric acute orbital cellulitis; Subperiosteal abscess; Surgical management.