External orbitotomy in subperiosteal abscess of the orbit: Patient characteristics and treatment results

Abstract

Purpose: To review the examination findings and treatment results in patients with orbital subperiosteal abscess who underwent orbitotomy and abscess drainage through skin incision.Material and Method: The records of 17 patients who had undergone surgical intervention for subperiosteal abscess from January 1998 to December 2009 were reviewed. The collected data included age, gender, radiological and clinical examination signs, microbiology results, treatment modalities, and follow-up time.Results: Eleven patients were males, and 6 were females; mean patient age was 22 years (range: 5-74 years). Thirteen patients (76%) were older than 9 years of age. Subperiosteal abscess was secondary to paranasal sinusitis in 14 patients (82%), and secondary to orbital trauma in 3 patients (18%). Location of abscess formation within the orbit were superior in 10 (59%), medial in 3 (18%) and superomedial in 4 patients (23%). Relative afferent pupillary defect was positive in 15 patients (88%). Radiologic scanning showed intracranial abscess formation in 2 patients (13%). Surgical treatment include orbitotomy and drainage of abscess in 17 patients (100%), and anterior ethmoidectomy in 4 patients (23%). One patient (6%) underwent drainage of intracranial abscess through craniotomy. Intraoperative cultures were positive in only 6 (35%) of 17 samples. Recurrence of the abscess and permanent loss of vision developed in 1 patient (6%). The follow-up period ranged from 3 to 14 months (mean, 5.5 months).Discussion: Subperiosteal orbital abscesses may lead to optic neuropathy and intracranial infection and may require surgical drainage for treatment. Abscess drainage through external orbitotomy may provide a rapid and complete resolution in orbital symptoms and visual functions.