MANAGEMENT OF MEDIAL SUBPERIOSTEAL ABSCESS OF THE ORBIT IS CHILDREN -A 5-YEAR EXPERIENCE

A medial subperiosteal abscess (SPA) of the orbit is the most common s erious complication of sinusitis in children. The distinction between SPA and the more benign pre-septal disease is difficult to make especi ally 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 s urgery reserved for those patients who do not respond to medical treat ment and in whom a medial SPA is confirmed by CT. Conventionally, the abscess is drained via an external incision and an ethmoidectomy is pe rformed at the same time. More recently, successful drainage of SPA's has been accomplished endoscopically via a intranasal approach with le ss morbidity and superior cosmesis. We present a 5 year experience of 24 patients with CT scans suggestive of medial SPA who underwent endos copic exploration of the medial subperiosteal orbital space. We discus s 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 complica tions of sinusitis. Copyright (C) 1997 Elsevier Science Ireland Ltd.