American Journal of Otolaryngology - Head and Neck Medicine and Surgery
Volume 32, Issue 1 , Pages 62-68, January 2011

Pediatric subperiosteal orbital abscess secondary to acute sinusitis: a 5-year review

  • Vincent Tan Eng Soon, MS ORL-HNS

      Affiliations

    • Corresponding Author InformationDepartment of Otorhinolaryngology, Head & Neck Surgery, Sarawak General Hospital, Jalan Hospital, 93400 Kuching, Malaysia. Tel.: +60 12 3140728.

Received 13 August 2009 published online 23 December 2009.

Article Outline

Abstract 

Objective

Subperiosteal orbital abscesses (SPOAs) secondary to acute sinusitis are rare occurrences in the pediatric age group, more so in the neonatal period. Here, a rare case of SPOA in a 38-day-old newborn later drained via endoscopic sinus surgery is included also. This review describes the demographic data, clinical history, treatment, microbiology results, complications, and outcome.

Methods

The admission records for all the patients who were admitted to the Pediatric Surgical Ward in Sarawak General Hospital, Kuching, Malaysia, between January 2004 and May 2009 were retrospectively reviewed. Records of patients who presented with preseptal cellulitis, orbital cellulitis, subperiosteal abscess (extraconal), orbital abscess (intraconal), and cavernous sinus thrombosis were closely studied. Ophthalmology consultations were obtained in all these cases. Ultimately, 3 patients having SPOA secondary to acute sinusitis were selected for this review.

Results

All patients were male with rapid onset of periorbital signs, absence of purulent rhinorrhea, and presence of significant thrombocytosis (exceeding 500 × 109/L). The 38-day-old newborn had mixed infection of methicillin-resistant coagulase-negative Staphylococcus bacteremia and local Acinetobacter eye infection with Staphylococcus aureus in the SPOA. All had medially located SPOA that was adequately drained via endoscopic sinus surgery, resulting in full recovery.

Conclusion

Newborns with preexisting risk factors and immature immunity are at risk of severe and rare infections. Contrast-enhanced paranasal sinus computed tomographic scan is mandatory and reliable to differentiate preseptal and postseptal orbital infection, as both conditions can present similarly and rapidly deteriorate. In the contrast-enhanced computed tomography–demonstrable SPOA, endoscopic sinus surgery drainage of the abscess proved to be safe and reliable as the main treatment modality. All patients recovered well without complications.

 

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1. Introduction 

Acute sinusitis is the predominant cause of orbital infection in children. An apparent redness or swelling of the orbital region can be a harbinger of a local orbital infection, a trauma, or more ominously, a spreading infection from the neighboring paranasal sinus. The clinician needs to be aware of the possibility of the paranasal sinus infection because the clinical symptoms may be subtle or even absent. Therefore, a high index of suspicion is often needed because a missed diagnosis or delayed treatment can result in potentially catastrophic complication, that is, loss of vision, intracranial extension of the infection, or disseminated sepsis.

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2. Material and methods 

The admission records of all the patients who were admitted to the Pediatric Surgical Ward (pediatric admission age criteria, up to 12 years old) in Sarawak General Hospital, Kuching, Sarawak, Malaysia, between January 2004 and May 2009 were retrospectively reviewed. Records of patients who presented with the Chandler et al [1] classification of orbital complications—preseptal cellulitis, orbital cellulitis, subperiosteal abscess (extraconal), orbital abscess (intraconal), and cavernous sinus thrombosis—were closely studied. Ophthalmology consultations were obtained in all these cases. The results are detailed in Table 1. Ultimately, 3 patients having subperiosteal orbital abscess (SPOA) were selected for this review. Their demographic data, clinical history, treatment, microbiology results, duration of hospital stay, complications, and outcome were reviewed.

Table 1. Orbital complications due to sinusitis and nonsinusitis causes
CasesSinusitis-related caseNon–sinusitis-related cases (trauma, eye, skin, systemic causes)Total cases
Preseptal cellulitis31417
Orbital cellulitis–33
SPOA (extraconal)3–3
Orbital abscess (intraconal)––0
Cavernous sinus thrombosis––0
Total61723

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3. Results 

3.1. Case 1 

A 38-day-old newborn, with a current weight of 4.34 kg, presented to the referring hospital with right periorbital swelling of 4 days' duration, which was increasing in size, associated with fever and yellowish eye discharge (Fig. 1). Ophthalmologic examination revealed absence of rapid pupillary afferent defect and limitation of eye movement on lateral gaze. There were no upper respiratory tract infection (URTI) symptoms. The mother was well antenatally, and the baby was born with a birth weight of 2.5 kg via full-term spontaneous vaginal delivery. However, it was complicated by birth asphyxia and presumed sepsis, requiring mechanical ventilation and 7 days of intravenous cefotaxime and crystalline penicillin. He was discharged well from the ward on the eighth day of life. On presentation to the referring hospital, the total white blood cell count (TWCC) was 17.4 × 109/L (reference range, 5.7–23.8 × 109/L) and the platelet count was 833 × 109/L (reference range, 150–400 × 109/L). He was also started on intravenous ceftazidime, cloxacillin, and metronidazole. On arrival on the third day, an urgent computed tomographic (CT) scan of the orbits and paranasal sinus was performed, demonstrating proptosis with a subperiosteal abscess collection measuring 3.1 × 1.9 cm on the medial wall of the right orbit displacing the medial rectus muscle and opacification of the ipsilateral ethmoid air cells. There was also dehiscence of the medial wall of the orbit (Fig. 2). A diagnosis of right SPOA secondary to acute ethmoiditis was made. He also began to develop fever of 39°C. The blood culture grew methicillin-resistant coagulase-negative Staphylococcus (CNS), and direct eye smear for Gram stain taken earlier showed Acinetobacter sp (sensitive to amikacin, ampicillin sulbactam, amoxicillin clavulanate, piperacillin, and imepenem; resistant to netilmicin, gentamicin, ceftazidime, and meropenem). Subsequently, an emergency endoscopic drainage procedure of the abscess was performed the same day. Intraoperatively, the right medial meatus area was edematous; and thick pus was drained after an opening was made through the region of lamina papyracea (LP). The pus grew Staphylococcus aureus (sensitive to penicillin, oxaxillin, vancomycin, clindamycin, and fusidic acid). Postoperatively, the newborn recovered uneventfully and was discharged on day 5 with broad-spectrum oral antibiotics.

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  • Fig. 1. 

    A 38-day-old newborn presenting with high fever, right periorbital swelling, and proptosis associated with yellowish eye discharge. Note through the palpebral fissure that the eye was also pushed laterally.

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  • Fig. 2. 

    Case 1. (A) Axial CECT scan showing a right SPOA (white arrow) causing proptosis and displacement of the medial rectus muscle. (B) Coronal CECT scan showing the medial collection (white arrow) with opacification of the maxillary sinus. However, the opacification of the ethmoid is less clear in this slice. Dehiscence is present in the medial wall of the orbit (black arrows) in both slices.

3.2. Case 2 

A previously healthy 4-year-old boy presented with 3 days' duration of progressively worsening left eye swelling and left ear purulent discharge with high fever of 38.5°C. There was no history of purulent rhinorrhea. On ophthalmologic examination, the left eye was proptosed, the upper eyelid was edematous, and the extraocular muscle movements were limited. Subconjuctival hemorrhage was also present on the medial aspect. Otoscopy revealed left otitis externa with inflamed dull tympanic membrane. His TWCC was 17.4 × 109/L and platelet count was 959 × 109/L. Paranasal sinus CT scans showed mucosal thickening in the left ethmoid air cells and bilateral maxillary antrum with a 2.2 × 0.5-cm subperiosteal collection in the left orbit displacing the medial rectus muscle with left mastoid effusion (Fig. 3). He was started on intravenous ceftriaxone, cloxacillin, and metronidazole with framycetin and gramicidin (Sofradex; Sanofi-Aventis, Paris, France) ear drops. Subsequently, an emergency endoscopic decompression of the abscess with anterior ethmoidectomy was performed the same day. The pus, blood, and eye swab cultures were unremarkable. He recovered well and was discharged on day 3 with broad-spectrum oral antibiotics.

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  • Fig. 3. 

    Case 2. (A) Coronal CECT scan showing left SPOA (black arrows) in the medial portion of the orbit with opacification of the ethmoidal air cells (white arrow). (B) Axial CECT scan of the bone window showing the opacification of the ipsilateral mastoid air cells (black arrow).

3.3. Case 3 

A 9-year-old boy presented with 7 days' duration of progressively worsening right eye swelling, headache, and fever. There was otherwise no purulent rhinorrhea. He was a known case of allergic rhinitis but was poorly compliant to treatment. On examination, the left eye was proptosed with subconjuctival hemorrhage present; and he had restricted extraocular movements. However, his visual acuity was normal. His TWCC was 17.1 × 109/L and platelet count was 526 × 109/L. He was started on intravenous ceftazidime and metronidazole. Paranasal sinus CT scans on day 2 showed mucosal thickening in the right ethmoid air cells and maxillary antrum with a subperiosteal abscess collection in the right orbit. He was then referred to the otorhinolaryngology unit on day 5; and subsequently, endoscopic drainage procedure of the abscess with anterior ethmoidectomy was performed the day after. There was no record of the pus sent for culture and sensitivity study. He recovered without complications, and he was discharged on the day 12 with broad-spectrum oral antibiotics.

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4. Discussion 

Orbital infection is an uncommon complication of acute sinus infection in pediatric age group, more so in the neonatal period. The results are summarized in Table 2. The most widely adopted system of classification or the orbital complications remains that of Chandler et al [1]. Another classification has been proposed by some authors [2] based on the surgical anatomy of the orbital periosteum, which serves as an anatomical barrier against orbital infection from the adjacent paranasal sinuses. The orbital septum, a thin connective tissue membrane arising from the anterior extension of the periosteum from the orbital margins into the eye lids, separates the superficial portion of the lids (preseptal region) from the deeper orbital structures (postseptal region). Generally, preseptal infection results in preseptal cellulitis; and postseptal infection can cause orbital cellulitis (an intraconal orbital infection), abscess collection in the intraconal (orbital abscess) and/or extraconal region (SPOA), or even cavernous sinus thrombosis as an intracranial extension of the infection. Causes of preseptal cellulitis include skin lesions (such as rashes, pustules), sinusitis, dacrocystitis, endophthalmitis, trauma, dental infection, and tumors. A worsening preseptal infection can spread into the postseptal space, but these conditions are not mutually exclusive of each other. Subperiosteal orbital abscess refers to the abscess collection in the potential space bordered by the LP medially and the periorbita laterally. Medial SPOA is the most common postseptal orbital complication of sinusitis [3], and the incidence of SPOA in orbital infections is about 15% [2]. In this series, preseptal infection was more common; and the ratio of total cases of preseptal (73.9%) to postseptal infection (26.1%) closely mirrors that of another series [4]. In orbital infections, the most common bacteria isolated are Haemophilus influenzae, S aureus, Streptococcus pyogenes, Staphylococcus epidermidis, Streptococcus pneumoniae, and group A Streptococcus [5]. Single aerobic pathogens were noted to be more common in infection within the first decade of life as compared with polymicrobial infection and more severe presentation of postseptal infection in the older group [6]. The best culture material will be obtained from direct sinus aspiration or by drainage of a subperiosteal or orbital abscess [7].

Table 2. Summary of SPOA patients' data
Case 1Case 2Case 3
Age38 d4 y9 y
SexMaleMaleMale
Duration of presenting symptoms (d)437
Presenting symptomsPeriorbital swelling, feverPeriorbital swelling, fever, left otorrheaPeriorbital swelling, fever, headache
Possible risk factorBirth asphyxia with presumed sepsisNil knownAllergic rhinitis (poor compliance)
TWCC (×109/L)17.417.417.1
Platelet count (×109/L)833959526
Side of SPOARightLeftLeft
Empirical antibiotic started on presentationCeftazidime, cloxacillin, metronidazoleCeftriaxone, cloxacillin, metronidazoleCeftazidime, metronidazole
Pus cultureS aureusNo growthNot documented
Blood cultureMethicillin-resistant CNSNo growthNot documented
Duration of discharge after surgery (d)316
Duration of hospital admission (d)5312

Neonatal orbital complications due to sinusitis are very rare; and to date, there are less than 10 reported cases in the literature. Here, case 1 represents a rare case of SPOA in a 38-day-old newborn. Although the baby did not present within the first 4 weeks of life to strictly qualify as a neonatal infection, it bore some similarities in the first of the 2 cases of neonatal orbital abscess reported by Cruz et al [8]. Although theirs was an intraconal orbital abscess that was later drained via an inferior transconjunctival orbitotomy, both these newborns presented with rapid onset of periorbital signs (swelling, proptosis, reduced eye mobility) around the 28-day period, S aureus infection, and dramatic recovery after surgical drainage.

Other than the documented evidence of S aureus in the SPOA, he also developed methicillin-resistant CNS bacteremia and a local Acinetobacter sp eye infection. Coagulase-negative Staphylococcus, of which the major group is S epidermidis, are frequently found on skin and mucous membranes; and they were often disregarded as contaminants of positive blood cultures in the past. Now, along with improved understanding of the role of its bacterial polysaccharide components in attachment and/or persistence on foreign materials, its pathogenic role in hospital-acquired infection has been given greater prominence, as it is also found to be the most common cause of bacteremia related to indwelling devices. It is also generally assumed that approximately 80% of nosocomial isolates and 30% to 40% of isolates obtained from healthy carriers or patients from the community demonstrate resistance to methicillin [9]. Acinetobacter species are generally opportunistic invaders, and most infections have been isolated to the hospital and surgical settings [10]. Acinetobacter infections of the eye are also rare, and this also demonstrates the emerging trend of common ocular infections being initiated by atypical bacteria.

Usually, healthy term newborns become colonized with normal flora acquired from their mothers and the environment within few days after birth; and S aureus colonization of skin and mucosal surfaces is common [11]. Despite the high rate of colonization with CNS or S aureus on the skin, umbilicus, or respiratory mucosa, the incidence of disease in the newborn, aside from cases of colonization by epidemic hospital strains, is very low [12]. Although the mother was healthy antenatally, the newborn had birth asphyxia during vaginal delivery and developed poor Apgar score. He was ventilated for 24 hours and was treated with broad-spectrum intravenous antibiotics for presumed sepsis. There were no other known risk factors for immunodeficiency. However, normal flora can result in infection when normal body or local defenses are impaired by underlying disease, prematurity, and the use of invasive devices or when the delicate balance of the normal flora is altered by antimicrobial therapy [12]. In the newborn, the phagocytosis function of the polymorphonuclear leukocytes, which is one of the host defense mechanisms against staphylococcal infection, is still immature [13]; and neither the cell-mediated nor humoral immune responses are fully developed, too [14]. In addition, the prolonged hospital admission with the use of nasogastric tube [15] and systemic broad-spectrum antimicrobials would have predisposed the newborn to staphylococcal nasopharynx colonization (either through direct access to the nasopharynx or nasal mucosal trauma) with subsequent invasion of the ethmoidal labyrinth in addition to a systemic nosocomial infection, respectively.

Staphylococcal ethmoiditis with concomitant orbital cellulitis in a neonate is a serious infection; and 2 of the 7 infants with orbital abscesses in a review [8] progressed to bacteremia and sepsis, as in case 1 here. In the same review, it was found that neonatal orbital cellulitis seems to be closely related to staphylococcal infection of the ethmoid sinus. Case 3 was also potentially at risk, as he was a known case of allergic rhinitis that was poorly compliant to treatment. A persistently inflamed nasal mucosa could have predisposed him to an acute sinusitis, hence the increased likelihood of orbital infection. In a relevant review [16], about a third of pediatric patients who developed complications of sinus disease reviewed in a study had a history of atopic illness suggesting atopy.

In this series, the patients all consistently present acutely (average of 4.7 days) with periorbital swelling with fever. Although the American Association of Pediatrics sinusitis management guidelines [17] recommend antibiotic for severe acute bacterial sinusitis defined by symptoms of high fever and purulent nasal discharge of at least 3 to 4 days' duration, in this series, all the patients had developed complications of acute sinusitis even in the absence of rhinorrhea. There was no obvious history of purulent rhinorrhea or nasal blockage in all of them. Therefore, the absence of URTI symptoms does not exclude the possibility of sinusitis and its complications. In a child presenting with periorbital cellulitis, infection from the adjacent paranasal sinuses still has to be excluded by a contrast-enhanced CT (CECT) scan, even in the absence of ear, nose, and throat symptoms. Full blood count examination in all the patients also revealed leukocytosis and significant thrombocytosis (more than 500 × 109/L) especially in the second case. The significance of marked thrombocytosis in relation to pediatric orbital infection, sinusitis, or URTI has not been mentioned in the English literature, although it was found to be a common (48%) finding among patients with lower respiratory tract infection, especially in those with more severe clinical condition and almost exclusively in patients with pleural effusion in another study [18]. An acute phase reaction in a severe infection would be the most likely cause here, but more studies should be conducted to determine any other relevant associations.

Contrast-enhanced CT was performed for all these cases soon after admission because they had severe periorbital swelling and proptosis with gaze limitation. Furthermore, it would not be possible to ascertain pre- or postseptal infection based on clinical history and presentation alone, compounded by the difficulty of a full nasal endoscopy and ophthalmologic examination in an uncooperative, crying child. Very often, pre- and postseptal infections can present similarly with periorbital swelling and chemosis, although loss of visual acuity and ophthalmoplegia would favor a postseptal infection. On the other hand, diminished rapid pupillary afferent defect can also be absent until irreversible loss of vision has occurred [19]. Therefore, this does not justify the morbidity of this potentially devastating condition where early diagnosis is vital to prevent vision loss and sepsis or even mortality. In the narrow space of the orbit, mass effect from the abscess or edema can cause direct compression of the optic nerve or the supplying vessels, thereby resulting in visual loss in a short span of time.

As objective ophthalmologic and nasal endoscopic assessment is often difficult and unreliable especially in a child, the CT scan is imperative to provide a definitive diagnosis on which the clinician will base his or her medical or surgical management. Although some authors [2] have certain criterion for CT scan, that is, inability to perform full ophthalmologic assessment and clinical deterioration despite 24 hours of antibiotic management, here it is recommended that CT scan be performed in all orbital infection because it also allows radiologic assessment of the paranasal sinus as the potential source of infection. CT scan was also agreed to be the most reliable diagnostic modality for SPOA due to the lack of specificity and difficulty of clinical signs and symptoms [20]. Magnetic resonance imaging, on the other hand, would be preferred if intracranial extension of infection is suspected. As illustrated in these 3 cases, the patients are asymptomatic of any URTI infection; but yet, there was significant opacification of the ethmoidal and maxillary sinuses. On the CT scan, the abscess collection presents as a hypodense lesion with peripheral enhancement. Occasionally, gas shadow can be seen, confirming the abscess. In all 3 cases here, although gas shadow was absent, the collection was situated in the medial extraconal compartment of the orbit, displacing the medial rectus muscle laterally. Incidentally, case 1 also demonstrated areas of dehiscence in the medial wall of the orbit. The role of LP, which has been a subject of debate in the literature, also deserves comment. Although not a prerequisite for abscess condition, congenital dehiscent or transparently thin LP dehiscence has been hypothesized to contribute to orbital infection [20], [21], although some argued that aggressive ethmoidal infection has instead resulted in the localized bony destruction, thus the absence of LP [22]. Although the scans are suggestive of a collection, the diagnosis of SPOA is only made at surgery when pus is drained. Although radiographic studies such as CT may often suggest the likelihood of a fluid collection, it is not possible to differentiate pus-containing abscesses from phlegmons [23], especially when the apparent fluid collection is small [24]. A phlegmon occurs as inflammatory collections present between the medial rectus and the medial orbital wall and, when surgically drained, reveals only granulation tissue with no growth of organisms in culture [7].

Paranasal sinusitis is responsible for 66% to 75% of cases of orbital infections, and the most common source of orbital cellulitis in children is ethmoidal sinusitis [25]. The location of the SPOA is also closely linked to the possible site of origin of the paranasal sinus infection. Typically, SPOA arising in the medial compartment is often associated with ethmoidal sinusitis and superomedial compartment with frontal sinusitis. However, in this series, although all had opacification of the adjacent ethmoid air cells, case 2 also had bilateral maxillary antrum opacification and case 3 had ipsilateral maxillary antrum opacification with ipsilateral acute otitis media and otitis externa, which later resolved with conservative treatment. Case 1 had an inferomedial SPOA that correlated with opacification of the adjacent ethmoidal and maxillary sinuses. Therefore, in this series, there is a strong association between SPOA and both the ethmoidal and maxillary sinus infection. The frontal and sphenoid sinuses were not well developed yet in all these patients. If frontal sinus is present, superior SPOA can occur secondary to frontal sinusitis and, hence, an increased risk of intracranial infection [26].

Whether an SPOA should be conservatively or surgically treated has been the subject of great debate in the current literature. Proponents for conservative management reasoned that the orbital periosteum is a resilient barrier to localize the SPOA, thus contributing to its resolution [27]. On the contrary, Harris [6] clearly recommended surgery once an abscess has been formed. The need for surgical intervention in those older than 10 years was also explained in that study as due to the more severe presentation of orbital cellulitis/abscess and higher likelihood of complex polymicrobial infection refractory to antibiotics. In an earlier literature review, even with appropriate antibiotics management, there was significant complication rate of 20% and a visual loss rate of 14% to 33% [27]. In 1998, another group [26] concluded that the medial SPOA secondary to sinusitis in children 6 years old and younger is highly amenable to treatment with intravenous antibiotics; however, the SPOA size in the selection criteria lacks measurement standardization. It also remains possible that the CT-demonstrated apparent fluid collection in some series advocating medical therapy only was a phlegmon rather than an actual abscess, hence the rapid resolution of collection with antibiotics alone, more so if the collection is small.

Later reviews had improved patient outcome because of more stringent selection criteria for conservative management. Some authors [28] proposed certain criteria for medical management of SPOA, that is, normal vision, pupil, and retina; absence of ophthalmoplegia in one or more directions of gaze; intraocular pressure of 20 mm Hg or less; proptosis of 5 mm or less; and abscess collection width of 4 mm or less on CT. In a recent study [24] comparing 68 patients with SPOA, of whom 47 were treated medically and 21 surgically, it was concluded that the surgical patients were older (8.3 vs 6.2 years), had larger abscesses (>10 mm), required a longer admission (10.2 vs 6.6 days), and had higher temperatures on admission (38.0°C vs 37.3°C). Although the author concurs that conservative management has a role in patients without visual compromise (provided that the patients are closely monitored by the ophthalmologist), the surgeon should be ready to perform a surgical drainage at the slightest doubt of the visual status or worsening clinical scenario. In this series, although they have been initially managed with antibiotics by other referring teams, they were drained at the earliest possible opportunity because they all presented to the ENT Department with significant ocular signs besides the radiologic evidence of an abscess collection. Despite aggressive broad-spectrum antibiotics management, the abscess persisted and needed drainage. Frank pus was present in all cases intraoperatively. However, it is difficult to conclude if medical treatment is truly ineffective because there were only 3 cases of SPOA in this series and all were surgically treated because of the significant visual signs. There were no SPOA cases that were conservatively managed; therefore, a comparison of the efficacy of surgical and medical management cannot be performed.

The route of surgical drainage is often determined by location of the SPOA. Although traditionally, medially located abscesses were drained by external approaches, transnasal endoscopic techniques have been found to be more advantageous because the latter not only drains the abscess effectively, but it also avoids facial scars and results in shorter hospital stay. Superiorly located SPOA, being less accessible to endoscopic techniques, usually require external drainage over the superior orbital rim, along with treatment of diseased sinuses, either endoscopically or with frontal sinus trephination. The timing of surgical intervention has been extensively discussed in the literature. Transnasal endoscopic approaches were used in all patients because of the medial location of the abscess collection. The patients recovered uneventfully after the endoscopic decompression and no repeated or additional surgical intervention was required in all cases. The patients were discharged soon (average of 3.3 days) after the surgery, and the average duration of hospital admission was 6.7 days. They were all well on subsequent follow-up.

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5. Conclusion 

In the management of SPOA, early diagnosis and control of infection by appropriate antimicrobial agents are of paramount importance. Contrast-enhanced paranasal sinus CT scan is mandatory and reliable to differentiate preseptal from postseptal orbital infection or abscess, as clinical presentation for both conditions can be similar and can deteriorate rapidly. In the CECT-demonstrable SPOA, endoscopic sinus surgery drainage of the abscess, as the main treatment modality, proved to be safe and reliable. Although orbital complications secondary to sinusitis in the pediatric community are rare, if not managed appropriately, this condition can be associated with significant morbidity and mortality.

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References 

  1. Chandler JR, Langbrunner DJ, Stevens ER. The pathogenesis of orbital complications in acute sinusitis. Laryngoscope. 1970;80:1414–1428
  2. Pereira KD, Mitchell RB, Younis RT, et al. Management of medial subperiosteal abscess of the orbit in children—a 5 year experience. Int J Pediatr Otorhinolaryngol. 1997;38:247–254
  3. Manning SC. Endoscopic management of medial subperiosteal orbital abscess. Arch Otolaryngol Head Neck Surg. 1993;119:789–791
  4. Jackson K, Baker SR. Periorbital cellulitis. Head Neck Surg. 1987;9:227–234
  5. Reddy SC, Sharma HS, Mazidah AS, et al. Case report: orbital abscess due to acute ethmoiditis in a neonate. Int J Pediatr Otorhinolaryngol. 1999;49:81–86
  6. Harris GJ. Subperiosteal abscess of the orbit: older children and adults require aggressive treatment. Ophthal Plast Reconstr Surg. 2001;17:395–397
  7. Jain A, Rubin PA. Orbital cellulitis in children. Int Ophthalmol Clin. 2001;41:71–86
  8. Cruz AVA, Mussi-Pinhata MM, Akaishi PMS, et al. Neonatal orbital abscess. Ophthalmol. 2001;108:2316–2320
  9. Huebner J, Goldmann DA. Coagulase-negative staphylococci: role as pathogens. Annu Rev Med. 1999;50:223–236
  10. Miller J. Acinetobacter as a causative agent in preseptal cellulitis. Optom. 2005;76:176–180
  11. Josephson A, Karanfil L, Alonso H, et al. Risk-specific nosocomial infection rates. Am J Med. 1991;91(Suppl 3B):131S–137S
  12. Jarvis WR. The epidemiology of colonization. Infect Control Hosp Epidemiol. 1996;17:47–52
  13. Carr R. Neutrophil production and function in newborn infants. Br J Haematol. 2000;110:18–28
  14. Wilson CB, Lewis DB, English BK. Immunity in the neonate. Semin Pediatr Infect Dis. 1999;10:83–90
  15. Bos AP, Tibboel T, Hazebroek FWJ, et al. Sinusitis: hidden source of sepsis in postoperative pediatric intensive care patients. Crit Care Med. 1989;17:886–888
  16. Sinclair CF, Berkowitz RG. Prior antibiotic therapy for acute sinusitis in children and the development of subperiosteal orbital abscess. Int J Pediatr Otorhinolaryngol. 2007;71:1003–1006
  17. American Academy of Pediatrics . Clinical practice guidelines: management of sinusitis. Pediatrics. 2001;108:798–808
  18. Vlacha V, Feketea G. Thrombocytosis in pediatric patients is associated with severe lower respiratory tract inflammation. Arch Med Res. 2006;37:755–759
  19. Patt BS, Manning SC. Blindness resulting from orbital complications of sinusitis. Otolaryngol Head Neck Surg. 1991;104:789–795
  20. Deutsch E, Eilon A, Hevron I, et al. Functional endoscopic sinus surgery of orbital subperiosteal abscess in children. Int J Pediatr Otorhinolaryngol. 1996;34:181–190
  21. Jatana KR, Grischkan JM, Skomorowski MJ, et al. Recurrent unilateral periorbital cellulitis in a pediatric patient - an anatomic abnormality. Int J Pediatr Otorhinolaryngol. 2008;72:1577–1580
  22. Rogers GA, Naseri I, Sobol SE. Methicillin-resistant Staphylococcus aureus orbital abscess in a neonate. Int J Pediatr Otorhinolaryngol Extra. 2007;2:99–101
  23. Handler LC, Davey IC, Hill JC, et al. The acute orbit: differentiation of orbital cellulitis from subperiosteal abscess by computerized tomography. Neuroradiol. 1991;33:15–18
  24. Ryan JT, Preciado DA, Bauman N, et al. Management of pediatric orbital cellulitis in patients with radiographic findings of subperiosteal abscess. Otolaryngol Head Neck Surg. 2009;140:907–911
  25. Moloney JR, Badham NJ, McRae A. The acute orbit. Preseptal (periorbital) cellulitis, subperiosteal abscess and orbital cellulitis due to sinusitis. J Laryngol Otol Suppl. 1987;12:1–18
  26. Greenberg ME, Pollard ZE. Medical treatment of pediatric subperiosteal orbital abscess secondary to sinusitis. J Am Assoc Pediatr Ophthalmol Strabismus. 1998;2:351–355
  27. Spires JR, Smith RJH. Bacterial infections of the orbital and periorbital soft tissue in children. Laryngoscope. 1986;96:763–767
  28. Oxford LE, McClay J. Medical and surgical management of subperiosteal orbital abscess secondary to acute sinusitis in children. Int J Pediatr Otorhinolaryngol. 2006;70:1853–1861

PII: S0196-0709(09)00221-X

doi:10.1016/j.amjoto.2009.10.002

American Journal of Otolaryngology - Head and Neck Medicine and Surgery
Volume 32, Issue 1 , Pages 62-68, January 2011

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