A retrospective study of surgically treated subperiosteal orbital abscesses derived from acute bacterial ethmoid sinusitis

• Main Authors: J.H. Therchilsen, A.A. Muhamad, A. Bilde, C. von Buchwald
• Format: Article
• Language: English
• Published: Stichting NASE 2019-10-01
• Series: Rhinology Online
• Subjects: subperiosteal orbital abscess; sinusitis complications; acute sinusitis; ess; fess
• Online Access: https://www.rhinologyonline.org/Rhinology_online_issues/manuscript_56.pdf

Background: Subperiosteal abscesses (SPOA) are a complication of acute purulent sinusitis, and their optimal treatment regime is a controversial topic. Some otolaryngologists consider surgery to be mandatory in the treatment of subperiosteal abscesses others advocate that especially paediatric patients can be treated medically in some cases. The purpose of this study was to evaluate our current treatment guidelines for subperiosteal abscesses. Methodology: A retrospective study was undertaken from 2010 to 2016, including patients registered with the diagnosis of subperiosteal abscesses derived from acute sinusitis based on clinical diagnoses, and CTs or MRIs. All patients received treatment with IV-antibiotics and were booked for prompt surgery. The main outcome measures were CT-measurements and intraoperatively identified pus. Treatment included antibiotic choice, microbiology, and outcomes. Results: Thirty-one patients were included in the study having the diagnosis of sinusitis and SPOA. Per operatively, we found pus in the subperiosteal space in 21/31 patients and 17 of the patients with available contrast-enhanced CT scans. When patients were grouped based on radiographically confirmed abscesses or not per the preoperative MRI or CT, we found that the presumed abscess volume was 0.83 mL greater in the patients, who had an abscess confirmed during surgery. Two patients needed endoscopic re-operation. In addition, three patients had sequela at the last follow-up, two with minor subjective sequelae due to oedema most likely resolving themselves over time and one with memory and concentration difficulties due to intracranial empyema. Conclusion: Endoscopic drainage of SPOA combined with an intravenous antibiotic is a safe and effective treatment strategy when executed in trained surgical hands, which is substantiated by low recurrence and morbidity rates. Because of the relatively high incidence of contrast-enhanced CT-confirmed subperiosteal abscesses that cannot be identified intraoperatively, we suggest considering other parameters such as volume of the abscess to determine whether surgical intervention is needed.