PubMed · 7905090
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A S Cross. 1994-01-29. Inducing an abscess.. https://doi.org/10.1016/s0140-6736(94)91106-1
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A medial subperiosteal abscess (SPA) of the orbit is the most common serious complication of sinusitis in children. The distinction between SPA and the more benign pre-septal disease is difficult to make especially in a young child in whom an ophthalmological evaluation is often difficult. Computerised tomography (CT) is the investigation of choice in making this distinction. Subperiosteal inflammatory disease of the orbit is initially treated with intravenous antibiotic therapy with surgery reserved for those patients who do not respond to medical treatment and in whom a medial SPA is confirmed by CT. Conventionally, the abscess is drained via an external incision and an ethmoidectomy is performed at the same time. More recently, successful drainage of SPA's has been accomplished endoscopically via a intranasal approach with less morbidity and superior cosmesis. We present a 5 year experience of 24 patients with CT scans suggestive of medial SPA who underwent endoscopic exploration of the medial subperiosteal orbital space. We discuss the current management of medial subperiosteal disease of the orbit in children and include a review of the literature. Also included is a clinical staging system which aids the management of orbital complications of sinusitis.
A retrospective review was performed on 39 patients with deep space neck infection admitted to the Children's Hospital of Wisconsin over a nine year period. The signs and symptoms as well as issues of diagnosis and treatment were reviewed with attention to the use of computed tomography (CT) scans. Beta hemolytic streptococcus was the most commonly cultured organism followed by alpha hemolytic streptococcus. Sixteen patients underwent CT scans. Twelve were diagnosed with an abscess by CT scan. An abscess was confirmed in ten patients. Necrotic lymph nodes mimicked abscesses on CT scans and resulted in negative surgical findings. Airway obstruction occurred in 30% of the children in the study. Children under the age of 36 months had a significantly higher rate of airway obstruction upon presentation compared to older children (P < 0.05). There should be a high index of suspicion of upper airway compromise in children under the age of 36 months with a deep neck infection.