Pediatric medial subperiosteal orbital abscess: medical management where possible

Christopher L Brown; Scott M Graham; Mark C Griffin; Richard J H Smith; Keith D Carter; Jeffrey A Nerad; Nancy M Bauman

doi:10.1177/194589240401800511

Journal article

Pediatric medial subperiosteal orbital abscess: medical management where possible

Christopher L Brown, Scott M Graham, Mark C Griffin, Richard J H Smith, Keith D Carter, Jeffrey A Nerad and Nancy M Bauman

American journal of rhinology, Vol.18(5), pp.321-327

09/2004

DOI: 10.1177/194589240401800511

PMID: 15586805

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Abstract

Controversy exists about the optimal management of subperiosteal orbital abscesses (SPOAs) in pediatric patients. Some otolaryngologists advocate immediate surgical drainage while others recommend medical management initially and reserve surgery for nonresponders. We hypothesized that patients who can be managed without surgery have identifiable features on presentation that may aid in predicting their response to medical therapy. A retrospective chart review was performed on all patients < or =18 years of age who were admitted to the University of Iowa between 1984 and 2001 with findings consistent with an SPOA on computed tomography imaging. Patients were divided into two groups: group I received medical treatment only while group II underwent surgical drainage of the abscess. Presenting features were compared between the two groups. Forty-two patients were identified with 17 group I patients and 25 group II patients. All patients had resolution of their SPOA and favorable outcomes. The following variables attained significance: group I patients were younger than group II patients (5.1 years versus 11 years; p < 0.0001), had less restriction of ocular motility (-1.0 versus -2.3), and were hospitalized for fewer days (6.5 days versus 9.6 days; p = 0.011). The following clinical variables did not vary significantly between the groups: gender, side of abscess, temperature, total white blood cell count, neutrophil count, chemosis, visual acuity, and proptosis. Culture results predominantly showed growth of anaerobic organisms (7/23). With increasing age, there was an increase in the number of organisms cultured (p = 0.005). A subset of patients with SPOAs can be managed medically. These patients tend to be younger and present with minimal restriction of ocular motility.

Orbital Diseases - surgery

Age Factors

Humans

Orbital Diseases - blood

Abscess - blood

Child, Preschool

Male

Visual Acuity

Orbital Diseases - therapy

Abscess - physiopathology

Orbital Diseases - physiopathology

Adolescent

Abscess - surgery

Abscess - therapy

Female

Retrospective Studies

Child

Details

Title: Subtitle: Pediatric medial subperiosteal orbital abscess: medical management where possible
Creators: Christopher L Brown - Department of Otolaryngology-Head and Neck Surgery, University of Iowa, Iowa City, Iowa 52242, USA
Scott M Graham
Mark C Griffin
Richard J H Smith
Keith D Carter
Jeffrey A Nerad
Nancy M Bauman
Resource Type: Journal article
Publication Details: American journal of rhinology, Vol.18(5), pp.321-327
DOI: 10.1177/194589240401800511
PMID: 15586805
NLM abbreviation: Am J Rhinol
ISSN: 1050-6586
eISSN: 1539-6290
Publisher: United States
Language: English
Date published: 09/2004
Academic Unit: Roy J. Carver Department of Biomedical Engineering; Molecular Physiology and Biophysics; Anatomy and Cell Biology; Stead Family Department of Pediatrics; Iowa Neuroscience Institute; Neurosurgery; Otolaryngology; Internal Medicine; Ophthalmology and Visual Sciences
Record Identifier: 9983980385802771

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