Bidirectional orbital approach enhances orbital abscess drainage

Objectives: Transnasal endoscopic management of subperiosteal orbital abscess (SPOA) secondary to acute rhinosinusitis has become very popular over the past two decades. We describe our transnasal endoscopic approach for orbital complications secondary to acute rhinosinusitis (SPOA and orbital abscess) and the efficacy criteria that can be used to ensure complete drainage. Methods: The charts of all patients who underwent surgery at Assaf Harofeh Medical Center between January 1993 and June 2007 were reviewed. Age, sex, clinical findings, antibiotic treatment, surgical procedure and outcome were recorded. Results: Nineteen patients with SPOA and three with orbital abscess underwent surgery during which wide exposure of the periorbita was performed. If the abscess was not identified, bidirectional orbital manipulation, while simultaneously keeping a seeker in the abscess space under endoscopic view, enhanced its identification and successful drainage. An immediate reduction in palpable orbital pressure was used as an efficacy criterion for adequate drainage. Conclusion: The transnasal endoscopic approach for SPOA and orbital abscess can be enhanced by wide exposure of the periorbita and bidirectional orbital manipulation. Keeping track of orbital pressure during surgery by palpating the eye can be used as an efficacy criterion for assessing adequate drainage.