title: Management of superior subperiosteal orbital abscess.
abstract: A superior subperiosteal orbital abscess (SSPOA) is a collection of purulent material between the periorbit and the superior bony orbital wall, and is typically a complication of frontal sinusitis. SSPOA is characteristically managed by classic external surgical drainage. The aim of our study was to assess the role of surgical intervention in SSPOA. A retrospective medical chart review of patients diagnosed with SSPOA secondary to rhinosinusitis between the year 2005 and 2013 was conducted. Collected data included age, gender, co-morbidity, clinical presentation, prior antibiotic management, CT scans, surgical approach, outcome and complications. Six patients were included in our study, three males and three females with a mean age of 22.8 (range 9-58). Two patients were treated with amoxicillin clavulanic acid for 3 days prior to admission. Only the youngest patient with the smallest abscess responded successfully to conservative treatment, while the rest were managed surgically: three patients were treated successfully by the endonasal endoscopic approach and two patients were treated by utilizing the combined endonasal endoscopic and external approach. In patients who underwent the combined approach, the abscess was located in a more antero-lateral position than those treated endonasal endoscopically only. The location of a SSPOA dictates the surgical approach. The most antero-lateral SSPOAs should be drained by the combined approach, while more posterior abscesses should be approached endoscopically. Furthermore, a small SSPOA is first to be reported to resolve with conservative treatment. Level 4 (case series).
authors.affiliation: Department of Otorhinolaryngology Head and Neck Surgery, Assaf Harofeh Medical Center, 70300, Zerifin, Israel. haim.ga@012.net.il.|Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel. haim.ga@012.net.il.
authors.forename: Haim
authors.initials: H
authors.lastname: Gavriel
authors.affiliation: Department of Otorhinolaryngology Head and Neck Surgery, Assaf Harofeh Medical Center, 70300, Zerifin, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
authors.forename: Basel
authors.initials: B
authors.lastname: Jabrin
authors.affiliation: Department of Otorhinolaryngology Head and Neck Surgery, Assaf Harofeh Medical Center, 70300, Zerifin, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
authors.forename: Ephraim
authors.initials: E
authors.lastname: Eviatar
mesh_terms: D000038:Abscess / Q000209:etiology / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D019980:Amoxicillin-Potassium Clavulanate Combination; D002648:Child; D004322:Drainage; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009916:Orbital Diseases / Q000209:etiology / Q000628:therapy*; D012189:Retrospective Studies; D012220:Rhinitis / Q000150:complications; D012852:Sinusitis / Q000150:complications; D055815:Young Adult; D065093:beta-Lactamase Inhibitors
chemical_list: D065093:beta-Lactamase Inhibitors; D019980:Amoxicillin-Potassium Clavulanate Combination
keywords: CT scan; Endoscopy; Management; Sinusitis; Subperiosteal orbital abscess; Superior; Surgical treatment