Management of frontal sinusitis-associated subperiosteal abscess in children less than 9 years of age.
To investigate practice patterns for cases of subperiosteal abscess (SPA) with concomitant frontal sinusitis to identify factors favorable to medical management in children <9 years of age.



The medical records of all pediatric cases of orbital and periorbital cellulitis admitted at a tertiary care center from 1999-2014 were reviewed retrospectively. Cases were included if radiography demonstrated sinusitis-associated SPA in children <9 years of age. Cases of SPA with ipsilateral frontal sinusitis were compared to cases of SPA without ispilateral frontal sinus involvement.



A total of 21 cases with ipsilateral frontal sinusitis and 76 without were included. Patients with frontal sinusitis had a higher incidence of nonmedial SPA compared to those without frontal sinus involvement (6/21 vs 5/76, P = 0.01). Yet a majority of SPAs in the frontal sinusitis group were located medially (15/21 [71%]). All patients with superior or superomedial SPA underwent early surgical intervention. However, 14 of 15 patients (93%) in the frontal sinusitis cohort with medial SPAs were managed successfully with medical therapy alone.



Medical management of frontal sinusitis-associated SPA appears safe for select children <9 years of age with medial abscess. Although frontal sinusitis is cited as a criterion for surgical drainage of SPA, this criterion should be refined to frontal sinusitis with superiorly located abscesses.
Vanderbilt Eye Institute, Vanderbilt University School of Medicine, Nashville, Tennessee.
Kenneth J
KJ
Taubenslag
Vanderbilt Eye Institute, Vanderbilt University School of Medicine, Nashville, Tennessee.
James G
JG
Chelnis
Vanderbilt Eye Institute, Vanderbilt University School of Medicine, Nashville, Tennessee. Electronic address: louise.mawn@vanderbilt.edu.
Louise A
LA
Mawn
D000038:Abscess / Q000209:etiology*; D000900:Anti-Bacterial Agents; D002481:Cellulitis; D002648:Child; D015331:Cohort Studies; D005260:Female; D015522:Frontal Sinusitis / Q000150:complications*; D006801:Humans; D008297:Male; D009916:Orbital Diseases; D010521:Periosteum / Q000473:pathology*; D012852:Sinusitis; D014057:Tomography, X-Ray Computed
D000900:Anti-Bacterial Agents