Author(s)
Stephen R. Chorney, MD, MPH
Adva Buzi, MD
Mark D. Rizzi, MD
Affiliation(s)
Children's Hospital of Philadelphia, Philadelphia, PA
Abstract:
Introduction: The surgical approach to pediatric subperiosteal orbital abscess (SPOA) is guided largely by abscess location within the orbit. While medially-based abscesses are amenable to endoscopic techniques, superolateral collections require an open approach. Concomitant endoscopic sinus surgery (ESS) is often performed at the time of open abscess drainage to enhance control of the infectious source and for acquisition of cultures. However, the necessity of ESS when the orbital abscess is externally drained has not been studied. Our objective is to evaluate the benefit of ESS in children who require open drainage of non-medial SPOA complicating acute sinusitis.
Methods: Retrospective review of children requiring surgical management for acute sinusitis complicated by non-medial SPOA at a tertiary children's hospital between November 2007 and September 2019.
Results: Sixteen children with an average age of 9.4 years (SD: 3.8) met inclusion. The male to female ratio was 5:3. Eleven children (68.8%) underwent combined external drainage and ESS, while five (31.2%) underwent external drainage alone. There were no differences in age at presentation (p=0.19), symptom duration (p=0.89), white blood cell count (p=0.63), C-reactive protein level (p=0.54), intraocular pressure (p=0.24), Lund-Mackay score (p=0.94), or abscess volume (p=0.22) between groups. Cultures identified alpha-hemolytic Streptococcus species in 50% of patients, with Streptococcus intermedius representing the most common organism in 31.3%. In one of 16 cases, ESS identified a pathogen not acquired via concomitant external drainage, which did influence management. No child required a subsequent surgical procedure and there were no complications. Average length of stay in patients undergoing combined approach versus external drainage alone (4.5 vs. 7.4 days) was not statistically significant (p=0.25).
Conclusion: The addition of ESS in the management of pediatric non-medial SPOA was associated with a shorter, albeit not statistically different, average length of stay in this series. Cultures obtained via concomitant ESS rarely aided in diagnosis. Concomitant ESS may not be necessary for some patients who undergo external drainage of non medial SPOA. Further study is required to delineate the indications for ESS in these cases.