Endoscopic sinus surgery for medial orbital subperiosteal abscess in children

Objective: To present our experience with endoscopically managed medial orbital subperiosteal abscess (MOSA) in children and to compare the results with external drainage of the abscess. Methods: A retrospective record review was conducted on 22 children with MOSA, of whom 6 underwent drainage by endoscopic sinus surgery (group 1) and 16 underwent external ethmoidectomy (group 2). MOSA was diagnosed by computed tomography of the orbits. Results: There were no postoperative sequelae in children treated endoscopically, in contrast to facial scarring, delayed healing, stitch abscess, unresolved diplopia, or recurrent periorbital cellulitis with or without subperiosteal abscess following external drainage. Streptococcus pneumoniae and Haemophilus influenzae were isolated in three children and one child in group 1, respectively, whereas the cultures were negative in the other two group 1 children who received antibiotics prior to admission. Streptococcus species were also the most common isolates in group 2 (50%), followed by H. influenzae (19%). The mean duration of postoperative healing was 4.2 ± 1.9 days (range 2-7 days) in group 1 and 8.6 ± 4.2 days (range 5-17) in group 2 (p = .005). The mean respective hospital stay was 6.0 ± 2.0 days (range 4-9 days) and 9.9 ± 4.2 days (range 5-18 days) (p = .02). One group 2 child with residual disease underwent revision external ethmoidectomy 5 weeks after the initial procedure. Recurrent periorbital cellulitis was successfully managed conservatively in two group 2 children, 3 and 10 months postoperatively in one child, and 3 months and 6 years postoperatively in the other. Conclusion: We recommend exclusive use of an endoscopic approach for treating MOSA and saving external ethmoidectomy for drainage of superior orbital abscesses.