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Alsughayer L, Sindi A, AlQuwayee M, Alhussien A, Makoshi L, Zakzouk A. Subperiosteal abscess volume; an objective indication for surgical management in pediatrics. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08894-5. [PMID: 39174678 DOI: 10.1007/s00405-024-08894-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2024] [Accepted: 08/03/2024] [Indexed: 08/24/2024]
Abstract
PURPOSE Subperiosteal abscess (SPA) can lead to devastating morbidity and mortality. Prompt management is important; however, the choice of management route is controversial. This study investigates factors associated with surgical management and defines a cut-off abscess volume prompting surgical intervention. METHODS SPA cases presented to King Saud University Medical City (KSUMC) from 2014 to 2023 were reviewed. The surgical approach was studied in association with factors including age, gender, symptoms and signs, laboratory results, computed tomography (CT) characteristics, medications, and surgical approach. Multiple statistical tests were used for analysis, including student t-test, chi-square, multiple logistic regression analysis, and receiver operating characteristic (ROC) analysis. RESULTS Patients were managed medically (n = 14, 45.16%) or surgically (n = 17, 54.84%). The average duration of antibiotics was 15 days. Superior SPA favors surgical management (OR = 6.722, CI [1.332-33.913], p = 0.029), along with the use of steroids (OR = 5.625, CI [0.915-34.572], p = 0.049), and abscess volume (OR = 10.003, CI [1.418-70.540], p < 0.001). However, the only factor attributing to a surgical decision on multivariate logistic regression analysis was abscess volume (OR = 5.126, CI [1.023-25.694], p = 0.047). SPA volume of ≥ 0.648 ml strongly prompts surgical management, with a sensitivity of 94.1% and a specificity of 71.4% (p = 0.000). CONCLUSION SPA volume increases the likelihood of surgical intervention by five times, especially when abscess volume is ≥ 0.648 ml.
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Affiliation(s)
- Luluh Alsughayer
- Department of Otolaryngology - Head and Neck Surgery, College of Medicine, King Saud University , Riyadh, Saudi Arabia.
- Otolaryngology - Head & Neck Surgery Department, King Saud University Medical City, Riyadh, Saudi Arabia.
| | - Abdullah Sindi
- Department of Otolaryngology - Head and Neck Surgery, College of Medicine, King Saud University , Riyadh, Saudi Arabia
- King Abdullah Medical Complex, Jeddah, Saudi Arabia
- Otolaryngology - Head & Neck Surgery Department, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Mohammed AlQuwayee
- Department of Radiology, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Ahmed Alhussien
- Department of Otolaryngology - Head and Neck Surgery, College of Medicine, King Saud University , Riyadh, Saudi Arabia
| | - Latifah Makoshi
- Department of Otolaryngology - Head and Neck Surgery, College of Medicine, King Saud University , Riyadh, Saudi Arabia
| | - Abdulmajeed Zakzouk
- Department of Otolaryngology - Head and Neck Surgery, College of Medicine, King Saud University , Riyadh, Saudi Arabia
- Otolaryngology - Head & Neck Surgery Department, King Saud University Medical City, Riyadh, Saudi Arabia
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Lu NE, Gardiner LA, McCoy JL, Dohar JE, Tobey ABJ. Characteristics and management of pediatric medial subperiosteal orbital abscesses. Int J Pediatr Otorhinolaryngol 2024; 182:111997. [PMID: 38852548 DOI: 10.1016/j.ijporl.2024.111997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 05/17/2024] [Accepted: 05/30/2024] [Indexed: 06/11/2024]
Abstract
INTRODUCTION Subperiosteal orbital abscesses (SPOA) are the most common suppurative complications of acute bacterial sinusitis. Medial SPOAs arise from infection of the ipsilateral ethmoid sinus and favor initial conservative management reserving surgical drainage for patients who do not demonstrate clinical improvement. No standard algorithm defining medical versus surgical treatment of medial SPOAs exist in the pediatric population. OBJECTIVES To identify a size cutoff for medial SPOAs to predict the likelihood for surgical drainage. METHODS This is a retrospective review of patients with medial SPOAs at a tertiary care center from 2003 to 2017. Diagnosis of SPOA was based on radiographic findings. Variables included are patient demographics, antibiotic therapy, surgical intervention, and length of stay. RESULTS 82 patients with a medial SPOA were included with an average age at presentation of 6.27 (range 0-15) years were included in this study. 62 patients were male (75.6 %), and 20 were female (24.4 %). The average abscess length was 16.1 mm, range 4.5-30.7 mm. The average abscess width was 4.17 mm, range 1.5-14.6 mm. The odds ratio for surgical treatment with every 1 mm increase in abscess width was 1.89 (95CI:1.33-2.69, p < 0.001). Abscesses over 3.6 mm width were 6.65 times more likely to undergo surgical drainage than those less than 3.6 mm (OR:6.65, 95CI:2.52-17.54, p < 0.001). The average(SD) length of stay was 5.4(3.0) days for patients who underwent surgery and 4.0(0.9) days for patients treated with conservative measures, p < 0.001. CONCLUSION Medial SPOAs greater than 3.6 mm were more likely to undergo surgical drainage; however there was no difference in the likelihood of drainage between anteriorly and posteriorly based medial abscesses. These findings help further characterize the landscape of pediatric subperiosteal abscesses that are managed with surgical drainage.
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Affiliation(s)
- Nathan E Lu
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
| | - Lauren A Gardiner
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jennifer L McCoy
- Division of Pediatric Otolaryngology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Joseph E Dohar
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA; Division of Pediatric Otolaryngology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Allison B J Tobey
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA; Division of Pediatric Otolaryngology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
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Gibbons AB, Van Brummen A, Bacorn C, Niknahad A, Chang SH, Jian-Amadi A, Chambers C, Zhang M, Li E. Orbital subperiosteal abscess in adolescents and adults: predictors and outcomes of nonsurgical management and surgical approaches. Orbit 2024:1-10. [PMID: 38815212 DOI: 10.1080/01676830.2024.2355650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 05/08/2024] [Indexed: 06/01/2024]
Abstract
PURPOSE The aim of this study was to assess predictors and outcomes of subperiosteal abscess (SPA) management in adolescents and adults at two tertiary care centers. METHODS This retrospective cohort study included cases of SPA from January 1 2000 to October 9 2022 at two institutions. Patients 9 years or older were categorized into surgical and nonsurgical cohorts. Surgical subgroups included those who underwent functional endoscopic sinus surgery (FESS) alone, external (transcutaneous or transconjunctival) orbitotomy alone, or combined FESS and external surgery. The presented features were assessed as potential treatment predictors. Outcomes included length of stay (LOS), final best-corrected visual acuity (BCVA), readmission rate, and reoperation rate. RESULTS Of the 159 SPA cases included, 127 (79.9%) underwent surgery and 32 (20.1%) were managed nonsurgically. The nonsurgical cohort was younger (p = .003) with smaller abscesses (p < .001) that were more likely to be medial (p < .001). The nonsurgical cohort had shorter LOS (p < .001); final BCVA and readmission rates were similarly favorable. Abscess location was correlated with surgical approach. Superior SPA that underwent FESS or external surgery alone had higher reoperation rates (57.1.0% and 58.3%, respectively) than combined (17.9%). External approach and FESS alone resulted in lower reoperation rates (15.4% and 15.0%, respectively) than combined (27.3%) for medial SPA. Subgroup analysis in the sinusitis cohort yielded similar results. CONCLUSIONS A trial of nonsurgical management may be safe and effective for select patients aged 9 years and older with sinusitis-derived, medial, and small SPA. When surgery is indicated, approach should be guided by abscess location to minimize reoperation risk.
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Affiliation(s)
- Alison B Gibbons
- Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Alexandra Van Brummen
- Department of Ophthalmology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Colin Bacorn
- The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ava Niknahad
- The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Shu-Hong Chang
- Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Arash Jian-Amadi
- Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Christopher Chambers
- Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Matthew Zhang
- Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Emily Li
- The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Afshar P, Aghajani A, Mohsenzadeh N, Heidari M, Rafizadeh SM, Abedinifar Z, Rajabi MT. Pediatric orbital subperiosteal abscess outbreak in Iran: characteristics and causes. Graefes Arch Clin Exp Ophthalmol 2024; 262:623-630. [PMID: 37851132 DOI: 10.1007/s00417-023-06266-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 09/25/2023] [Accepted: 10/01/2023] [Indexed: 10/19/2023] Open
Abstract
PURPOSE To evaluate demographics, characteristics, and management of pediatric patients with subperiosteal abscesses (SPA) secondary to orbital cellulitis and discuss the etiology of a dramatic rise in SPA. METHODS Data were gathered by retrospective chart review of patients admitted to a tertiary referral eye hospital (Farabi Eye Hospital) diagnosed with orbital cellulitis with subperiosteal abscess from October 2022 to March 2023 (six months). Data on demographic information, clinical examination, radiographic evidence of sinusitis, orbital cellulitis, SPA, surgical and non-surgical management taken, isolated bacteria, and duration of hospital stay were gathered. RESULTS 24 patients were admitted during these six months, with a diagnosis of orbital SPA secondary to paranasal sinusitis, confirmed by an orbital Computed Tomography (CT) scan. The age range was 11 months to 16 years. 75% of patients were male. All patients had a history of flu-like illness before developing orbital cellulitis. All patients had concurrent sinusitis, and 18 underwent initial surgical abscess drainage. The ethmoid sinus was the most involved, and most patients had a medially located SPA. Abscess volume ranged from 0.78 to 7.81 cm3 (mean: 3.52 cm3). One patient had concurrent central retinal artery occlusion due to orbital cellulitis. CONCLUSIONS In this study, we report a dramatic increase in the incidence of SPA referred to our hospital. Larger abscess volumes and an increased number of cases that needed initial surgical drainage are also of note. An influenza outbreak in the autumn and winter, undiagnosed Corona Virus Disease 2019 (COVID-19) infection, increased antimicrobial resistance due to excessive off-label use of antibiotics during the COVID-19 pandemic, and more virulent bacterial infections are the most probable hypotheses to justify this observation.
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Affiliation(s)
- Pedram Afshar
- Department of Orbital and Oculoplastic Surgery, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirhossein Aghajani
- Department of Orbital and Oculoplastic Surgery, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Navid Mohsenzadeh
- Department of Orbital and Oculoplastic Surgery, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mostafa Heidari
- Department of Orbital and Oculoplastic Surgery, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Mohsen Rafizadeh
- Department of Orbital and Oculoplastic Surgery, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Zohreh Abedinifar
- Department of Pathology and Microbiology, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Taher Rajabi
- Department of Orbital and Oculoplastic Surgery, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Balaraj S, Sridhar A, Sajith M, Channegowda C. Transnasal endoscopic drainage of neonatal orbital abscess. BMJ Case Rep 2023; 16:e255145. [PMID: 37802596 PMCID: PMC10565282 DOI: 10.1136/bcr-2023-255145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023] Open
Abstract
Neonatal orbital complications are rare and potentially fatal, demanding prompt diagnosis and adequate treatment. A 25-day-old neonate presented with rapidly progressive orbital complications as evidenced by proptosis, chemosis, lid oedema and restricted eye movements, developing within 3 days. There was no significant medical history or risk factors for developing infection. An initial conservative approach with antimicrobial therapy failed to show any resolve. An MRI brain, orbits and paranasal sinuses demonstrated that there were features suggestive of right orbital cellulitis with possibility of abscess formation with right ethmoidal mucoinflammatory disease and mass effect on the optic nerve causing stretching and compression by the surrounding inflammation.The patient was treated successfully with transnasal endoscopic drainage and decompression. Endoscopic access was challenging owing to the restrictive anatomy. Postoperatively, the patient showed improvement, with gradual decrease in proptosis and resolve in eye movements.
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Affiliation(s)
| | | | - Milu Sajith
- ENT, MS Ramaiah Medical College, Bangalore, Karnataka, India
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Fu R, Bandos A, Leader JK, Melachuri S, Pradeep T, Bhatia A, Narayanan S, Campbell AA, Zhang M, Sahel JA, Pu J. Artificial Intelligence Automation of Proptosis Measurement: An Indicator for Pediatric Orbital Abscess Surgery. Ophthalmol Ther 2023; 12:2479-2491. [PMID: 37351837 PMCID: PMC10441912 DOI: 10.1007/s40123-023-00754-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 06/08/2023] [Indexed: 06/24/2023] Open
Abstract
INTRODUCTION To evaluate the ability of artificial intelligence (AI) software to quantify proptosis for identifying patients who need surgical drainage. METHODS We pursued a retrospective study including 56 subjects with a clinical diagnosis of subperiosteal orbital abscess (SPOA) secondary to sinusitis at a tertiary pediatric hospital from 2002 to 2016. AI computer software was developed to perform 3D visualization and quantitative assessment of proptosis from computed tomography (CT) images acquired at the time of hospital admission. The AI software automatically computed linear and volume metrics of proptosis to provide more practice-consistent and informative measures. Two experienced physicians independently measured proptosis using the interzygomatic line method on axial CT images. The AI software and physician proptosis assessments were evaluated for association with eventual treatment procedures as standalone markers and in combination with the standard predictors. RESULTS To treat the SPOA, 31 of 56 (55%) children underwent surgical intervention, including 18 early surgeries (performed within 24 h of admission), and 25 (45%) were managed medically. The physician measurements of proptosis were strongly correlated (Spearman r = 0.89, 95% CI 0.82-0.93) with 95% limits of agreement of ± 1.8 mm. The AI linear measurement was on average 1.2 mm larger (p = 0.007) and only moderately correlated with the average physicians' measurements (r = 0.53, 95% CI 0.31-0.69). Increased proptosis of both AI volumetric and linear measurements were moderately predictive of surgery (AUCs of 0.79, 95% CI 0.68-0.91, and 0.78, 95% CI 0.65-0.90, respectively) with the average physician measurement being poorly to fairly predictive (AUC of 0.70, 95% CI 0.56-0.84). The AI proptosis measures were also significantly greater in the early as compared to the late surgery groups (p = 0.02, and p = 0.04, respectively). The surgical and medical groups showed a substantial difference in the abscess volume (p < 0.001). CONCLUSION AI proptosis measures significantly differed from physician assessments and showed a good overall ability to predict the eventual treatment. The volumetric AI proptosis measurement significantly improved the ability to predict the likelihood of surgery compared to abscess volume alone. Further studies are needed to better characterize and incorporate the AI proptosis measurements for assisting in clinical decision-making.
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Affiliation(s)
- Roxana Fu
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Andriy Bandos
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Joseph K Leader
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Samyuktha Melachuri
- School of Medicine, University of Pittsburgh, 1400 Locust St, Suite 500, Pittsburgh, PA, 15219, USA.
| | - Tejus Pradeep
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA, USA
| | - Aashim Bhatia
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Srikala Narayanan
- Department of Radiology, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Ashley A Campbell
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins, Baltimore, MD, USA
| | - Matthew Zhang
- Department of Ophthalmology, University of Washington, Seattle, WA, USA
| | - José-Alain Sahel
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jiantao Pu
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
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Fu R, Schempf T, Vloka C, Jabbour N, Bhatia A, Shinder R, Hodgson N. Progression of Subperiosteal Orbital Abscess after Clinical Resolution on Intravenous Antibiotics and Steroids. Ocul Immunol Inflamm 2023; 31:1555-1558. [PMID: 36288474 PMCID: PMC10130235 DOI: 10.1080/09273948.2022.2134897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 09/30/2022] [Accepted: 10/05/2022] [Indexed: 10/31/2022]
Abstract
We present a case of a 7-year-old boy who was presented with a small medial subperiosteal orbital abscess (SPOA) and trace superior phlegmon and who was initially treated with intravenous (IV) antibiotics, corticosteroids, and observation. After clinical resolution and discharge, the patient returned with superior migration of his abscess requiring surgical drainage. Potential factors leading to readmission are discussed, including the anti-inflammatory and immunosuppressant effects of steroids, and presence of early surgical indictors such as bony dehiscence and proptosis. This case highlights the need for careful consideration of initial imaging and presence of a non-medial phlegmon prior to initiation of steroids.
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Affiliation(s)
- Roxana Fu
- University of Pittsburgh, Department of Ophthalmology
| | - Tadhg Schempf
- University of Pittsburgh, Department of Ophthalmology
| | | | - Noel Jabbour
- University of Pittsburgh, Department of Otolaryngology
| | - Aashim Bhatia
- Children’s Hospital of Pittsburgh, Department of Radiology
| | - Roman Shinder
- SUNY Downstate Health Sciences University, Department of Ophthalmology
| | - Nickisa Hodgson
- SUNY Downstate Health Sciences University, Department of Ophthalmology
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McKerlie MF, Wolter NE, Mahant S, Cichon J, Widjaja E, Drouin O, Pound C, Quet J, Wahi G, Bayliss A, Vomiero G, Foulds JL, Kanani R, Sakran M, Sehgal A, Borkhoff CM, Pullenayegum E, Reginald A, Parkin PC, Gill PJ. Abscess volume as a predictor of surgical intervention in children hospitalized with orbital cellulitis: A multicentre cohort study. Int J Pediatr Otorhinolaryngol 2023; 171:111629. [PMID: 37437497 DOI: 10.1016/j.ijporl.2023.111629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 06/04/2023] [Accepted: 06/07/2023] [Indexed: 07/14/2023]
Abstract
IMPORTANCE Orbital cellulitis with subperiosteal or orbital abscess can result in serious morbidity and mortality in children. Objective volume criterion measurement on cross-sectional imaging is a useful clinical tool to identify patients with abscess who may require surgical drainage. OBJECTIVE To determine the predictive value of abscess volume and the optimal volume cut-point for surgical intervention. DESIGN We conducted an observational cohort study using medical records from children hospitalized between 2009 and 2018. SETTING Multicentre study using data from 6 children's hospitals. PARTICIPANTS Children were included if they were between 2 months and 18 years of age and hospitalized for an orbital infection with an abscess confirmed on cross-sectional imaging. EXPOSURE Subperiosteal or orbital abscess volume. MAIN OUTCOME AND MEASURES The primary outcome was surgical intervention, defined as subperiosteal and/or orbital abscess drainage. Multivariable logistic regression was performed to assess the association of abscess volume with surgery. To determine the optimal abscess volume cut-point, receiver operating characteristic (ROC) analysis was performed using the Youden Index to optimize sensitivity and specificity. RESULTS Of the 150 participants (mean [SD] age, 8.5 [4.5] years), 68 (45.3%) underwent surgical intervention. On multivariable analysis, larger abscess volume and non-medial abscess location were associated with surgical intervention (abscess volume: adjusted odds ratio [aOR], 1.46; 95% CI, 1.11-1.93; abscess location: aOR, 3.46; 95% CI, 1.4-8.58). ROC analysis demonstrated an optimal abscess volume cut-point of 1.18 mL [AUC: 0.75 (95% CI 0.67-0.83) sensitivity: 66%; specificity: 79%]. CONCLUSIONS AND RELEVANCE: In this multicentre cohort study of 150 children with subperiosteal or orbital abscess, larger abscess volume and non-medial abscess location were significant predictors of surgical intervention. Children with abscesses >1.18 mL should be considered for surgery.
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Affiliation(s)
- Morgyn F McKerlie
- Queens School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Nikolaus E Wolter
- The Hospital for Sick Children, Toronto, ON, Canada; Department of Otolaryngology, Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Sanjay Mahant
- The Hospital for Sick Children, Toronto, ON, Canada; Department of Pediatrics, University of Toronto, Toronto, ON, Canada; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Jessica Cichon
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON, Canada
| | - Elysa Widjaja
- The Hospital for Sick Children, Toronto, ON, Canada; Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Olivier Drouin
- Department of Pediatrics, Université de Montreal, Montreal, QC, Canada; Division of General Pediatrics, Department of Pediatrics, CHU Sainte-Justine, Montreal, QC, Canada; Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal, QC, Canada
| | - Catherine Pound
- Department of Pediatrics, University of Ottawa, Children's Hospital of Eastern Ontario (CHEO), Ottawa, ON, Canada
| | - Julie Quet
- Department of Pediatrics, University of Ottawa, Children's Hospital of Eastern Ontario (CHEO), Ottawa, ON, Canada
| | - Gita Wahi
- Department of Pediatrics, McMaster University, McMaster Children's Hospital, Hamilton, ON, Canada
| | - Ann Bayliss
- Trillium Health Partners, Department of Paediatrics, University of Toronto, Mississauga, ON, Canada
| | - Gemma Vomiero
- Department of Pediatrics, University of Calgary, Alberta Children's Hospital, Calgary, AB, Canada
| | - Jessica L Foulds
- Department of Pediatrics, University of Alberta, Stollery Children's Hospital, Edmonton, AB, Canada
| | - Ronik Kanani
- North York General Hospital, University of Toronto, Toronto, ON, Canada
| | - Mahmoud Sakran
- Department of Paediatrics, Queens University, Lakeridge Health, Oshawa, ON, Canada; Research, Lakeridge Health, Oshawa, ON, Canada
| | - Anupam Sehgal
- Kingston Health Sciences Centre, Queen's University, Kingston, ON, Canada
| | - Cornelia M Borkhoff
- The Hospital for Sick Children, Toronto, ON, Canada; Department of Pediatrics, University of Toronto, Toronto, ON, Canada; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Eleanor Pullenayegum
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Arun Reginald
- The Hospital for Sick Children, Toronto, ON, Canada; Department of Ophthalmology and Visual Sciences, University of Toronto, Toronto, ON, Canada
| | - Patricia C Parkin
- The Hospital for Sick Children, Toronto, ON, Canada; Department of Pediatrics, University of Toronto, Toronto, ON, Canada; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Peter J Gill
- The Hospital for Sick Children, Toronto, ON, Canada; Department of Pediatrics, University of Toronto, Toronto, ON, Canada; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
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Panda BB, Behera S, Vishwanath S. Successful Management of an Acute Case of Orbital Cellulitis of Odontogenic Origin. J Emerg Trauma Shock 2023; 16:29-30. [PMID: 37181743 PMCID: PMC10167824 DOI: 10.4103/jets.jets_112_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 08/31/2022] [Accepted: 09/06/2022] [Indexed: 03/29/2023] Open
Affiliation(s)
- Bijnya Birajita Panda
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | | | - Shilpa Vishwanath
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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10
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Sha Kri Eh Dam V, Abdullah B. Acute rhinosinusitis with subperiosteal abscess. VISUAL JOURNAL OF EMERGENCY MEDICINE 2022; 29:101439. [DOI: 10.1016/j.visj.2022.101439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
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Wu PW, Lin YL, Lee YS, Chiu CH, Lee TJ, Huang CC. Predictors of Surgical Intervention for Pediatric Acute Rhinosinusitis with Periorbital Infection. J Clin Med 2022; 11:jcm11133831. [PMID: 35807115 PMCID: PMC9267572 DOI: 10.3390/jcm11133831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/28/2022] [Accepted: 06/29/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Medical versus surgical management of pediatric periorbital infection secondary to acute bacterial rhinosinusitis (ABRS) can be a dilemma for clinicians. This study aimed to evaluate the prognostic factors related to the need for surgical drainage and to help direct management decisions. Methods: Children admitted for periorbital infection secondary to ABRS between 2001 and 2019 were retrospectively reviewed. Demographics, clinical presentations, laboratory data, comorbidities, and computed tomography results were collected from medical records. Results: A total of 141 pediatric patients were enrolled. Forty-two patients (29.8%) required surgical intervention. Multivariate logistic regression analysis identified that delayed initiation of intravenous antibiotics from the onset of periorbital swelling (odds ratio [OR] = 1.94; p < 0.001) and proptosis at initial presentation (OR = 6.63; p = 0.008) were significantly associated with the need for surgical intervention. A C-reactive protein value of > 55.73 mg/L and initiation of intravenous antibiotic treatment > 2 days from the onset of periorbital swelling showed the best predictive power for surgery. Conclusions: Pediatric patients with delayed initiation of intravenous antibiotic treatment and initial presentation of proptosis had worse outcomes and required surgical intervention.
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Affiliation(s)
- Pei-Wen Wu
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (P.-W.W.); (T.-J.L.)
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
| | - Yen-Ling Lin
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan;
| | - Yun-Shien Lee
- Genomic Medicine Research Core Laboratory, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan;
- Department of Biotechnology, Ming Chuan University, Taoyuan 333, Taiwan
| | - Cheng-Hsun Chiu
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan
| | - Ta-Jen Lee
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (P.-W.W.); (T.-J.L.)
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
- Department of Otolaryngology, Xiamen Chang Gung Hospital, Xiamen 102218, China
| | - Chien-Chia Huang
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (P.-W.W.); (T.-J.L.)
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Correspondence: ; Tel.: +886-3-3281200 (ext. 8465)
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Morse E, Ray A, Donaldson AM. Management of Acute Pediatric Rhinosinusitis. CURRENT TREATMENT OPTIONS IN ALLERGY 2022. [DOI: 10.1007/s40521-022-00301-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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13
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J. Welkoborsky H, Pitz S, Grass S, Breuer B, Pähler vor der Holte A, Bertram O, Wiechens B. Sinogenic Orbital Complications. DEUTSCHES ARZTEBLATT INTERNATIONAL 2022; 119:31-37. [PMID: 34874263 PMCID: PMC9011833 DOI: 10.3238/arztebl.m2021.0379] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 03/04/2021] [Accepted: 11/08/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND The term "orbital complication" does not designate an independent nosological entity, but is rather a collective designation for diseases or disease effects that involve the orbit and its internal structures by extension from outside. In general, their most prominent manifestation is swelling of the orbital soft tissues, usually unilaterally. The incidence of sinogenic orbital complications is approximately 1.6 per 100 000 children and 0.1 per 100 000 adults per year. METHODS This review is based on publications retrieved by a selective search of the literature on the epidemiology, diagnosis, and treatment of sinogenic orbital complications. RESULTS Acute sinusitis is the most common cause of orbital complications. These are diseases of the orbit with potentially serious consequences for the eye and the risk of intracranial complications such as cavernous sinus thrombosis, meningitis, or brain abscess. Aside from acute sinusitis, many other infectious and non-infectious diseases can extend to and involve the orbit. Because of the complexity and severity of the condition, its diagnosis and treatment are always an interdisciplinary matter. The treatment is primarily conservative, under observation in a hospital, and generally consists of the treatment of acute sinusitis with measures to combat edema along with the administration of broad-spectrum antibiotics. Surgical intervention is needed in severe cases or if there is an abscess. An endonasal approach is usually used for drainage. CONCLUSION In 95-98% of cases in stages I-IV, healing is complete and without further sequelae. Even if vision is affected preoperatively, it usually recovers fully when therapy is appropriate. Approximately 15% of the patients who undergo surgery need more than one operative procedure.
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Affiliation(s)
- Hans J. Welkoborsky
- Department of Otorhinolaryngology, Head and Neck Surgery, Nordstadt Clinic, Academic Hospital, Hanover, Germany,Department for ENT Medicine, Center for Children and Adolescents, Hanover,*Regional Hospital Hanover Department of Otorhinolaryngology Haltenhoffstr. 41 30167 Hanover, Germany
| | - Susanne Pitz
- Academic Medical Center, Interdisciplinary Orbita Center, Department of Ophthalmology, Hanover,Bürger Hospital, Orbita Center, Ophthalmic Clinic, Frankfurt/M
| | - Sylvia Grass
- Department of Otorhinolaryngology, Head and Neck Surgery, Nordstadt Clinic, Academic Hospital, Hanover, Germany
| | - Boris Breuer
- Academic Medical Center, Interdisciplinary Orbita Center, Department of Ophthalmology, Hanover
| | - Anja Pähler vor der Holte
- Department of Otorhinolaryngology, Head and Neck Surgery, Nordstadt Clinic, Academic Hospital, Hanover, Germany
| | - Oliver Bertram
- Department for ENT Medicine, Center for Children and Adolescents, Hanover
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14
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Saltagi MZ, Rabbani CC, Patel KS, Wannemuehler TJ, Chundury RV, Illing EA, Ting JY. Orbital Complications of Acute Sinusitis in Pediatric Patients: Management of Chandler III Patients. ALLERGY & RHINOLOGY 2022; 13:21526575221097311. [PMID: 35496892 PMCID: PMC9052236 DOI: 10.1177/21526575221097311] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Surgery is often avoided in the setting of pediatric orbital complications from acute sinusitis unless necessitated by alarming ophthalmological signs. Criteria for surgical intervention are not well-defined. Objective We aim to review our experiences, management practices and patient outcomes over a ten-year period for Chandler III patients. Methods A retrospective review was performed from January 1, 2007 through December 31, 2016 of patients treated for orbital symptoms secondary to acute sinusitis at a free-standing tertiary-care pediatric hospital. Results Of the 186 patients reviewed, 42 Chandler III patients were included. Average age was 82.6 months (SD 50.6) with a slight male predominance (M to F, 1.8 to 1). 27 patients (64.3%) underwent intervention including endoscopic sinus surgery (ESS) with or without orbitotomy. Late surgical intervention (>48hrs from admission) demonstrated significant increase in overall length of stay (LOS) when compared with early surgical intervention and/or medical management (median, 6.9 vs 3.6 vs 3.7 days; p < 0.01). Postoperative LOS was also higher in the late surgery group compared with patients who had surgery within 48 hours of admission, but this did not reach statistical significance [median, 3.8 vs 2.8 days, p= 0.12]. There was no significant difference in overall abscess volume between patients who underwent intervention and those who did not (1019 mm3 vs 805 mm3, p = 0.5), but abscess width ≥ 1.2 cm was associated with higher rates of intervention. An alarming extraocular exam was the most common factor associated with surgical intervention. Conclusion Pediatric subperiosteal orbital abscess may prompt surgical intervention by ESS. An alarming ophthalmologic exam should prompt consideration of early intervention, which may lead to decreased overall and post-operative length of hospital stay. Level of Evidence 4 Meeting Information American Rhinologic Society, Fall National Meeting. Chicago, IL, USA. September 8–9, 2017.
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Affiliation(s)
- Mohamad Z. Saltagi
- Department of Otolaryngology—Head and Neck Surgery, Indianapolis, IN, USA
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Cyrus C. Rabbani
- Department of Otolaryngology—Head and Neck Surgery, Indianapolis, IN, USA
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Kunal S. Patel
- Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Ophthalmology, Indianapolis, IN, USA
| | - Todd J. Wannemuehler
- Department of Otolaryngology—Head and Neck Surgery, Indianapolis, IN, USA
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Rao V. Chundury
- Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Ophthalmology, Indianapolis, IN, USA
| | - Elisa A. Illing
- Department of Otolaryngology—Head and Neck Surgery, Indianapolis, IN, USA
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jonathan Y. Ting
- Department of Otolaryngology—Head and Neck Surgery, Indianapolis, IN, USA
- Indiana University School of Medicine, Indianapolis, IN, USA
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15
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Raponi I, Giovannetti F, Buracchi M, Priore P, Battisti A, Scagnet M, Genitori L, Valentini V. Management of orbital and brain complications of sinusitis: A practical algorithm. J Craniomaxillofac Surg 2021; 49:1124-1129. [PMID: 34607756 DOI: 10.1016/j.jcms.2021.09.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/24/2021] [Accepted: 09/08/2021] [Indexed: 10/20/2022] Open
Abstract
The aim of this work was to present a practical management algorithm for orbital and brain complications of sinusitis. According to the inclusion criteria, a sample of 68 patients was collected between 2008 and 2018 (39 males and 29 females). Among them, 44 were adults, with a mean age of 50.46 years, and 24 were pediatric patients, with a mean age of 10.33 years. Oral or intravenous antibiotic therapy was administered to all patients. Pharmacological resolution was observed in 14 cases. Early surgical treatment within 48 hours was necessary in 10 cases. Surgery consisted of abscess drainage, associated or not with functional endoscopic sinus surgery. Delayed surgery within 15-30 days was performed in 44 patients. The core procedure was functional endoscopic sinus surgery. Subsidiary procedures were abscess drainage, tooth extraction or cranial base repair. The combination of two or more of these procedures was case selected. Median follow-up was of 46.36 months. Sinusitis complications necessitate rapid diagnosis and prompt treatment. Antibiotic therapy alone is enough for mistreated rhinosinusitis with no anatomical predisposing factor. Surgery is mandatory for altered nasal and paranasal sinus anatomy or odontogenic infections.
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Affiliation(s)
- Ingrid Raponi
- Department of Maxillofacial Surgery, Sapienza University of Rome, Rome, Lazio, Italy.
| | - Filippo Giovannetti
- Department of Maxillofacial Surgery, Sapienza University of Rome, Rome, Lazio, Italy; Department of Neurosurgery, Meyer Children's Hospital, Florence, Toscana, Italy
| | - Matteo Buracchi
- Department of Maxillofacial Surgery, Sapienza University of Rome, Rome, Lazio, Italy
| | - Paolo Priore
- Department of Maxillofacial Surgery, Sapienza University of Rome, Rome, Lazio, Italy.
| | - Andrea Battisti
- Department of Maxillofacial Surgery, Sapienza University of Rome, Rome, Lazio, Italy
| | - Mirko Scagnet
- Department of Neurosurgery, Meyer Children's Hospital, Florence, Toscana, Italy
| | - Lorenzo Genitori
- Department of Neurosurgery, Meyer Children's Hospital, Florence, Toscana, Italy
| | - Valentino Valentini
- Department of Maxillofacial Surgery, Sapienza University of Rome, Rome, Lazio, Italy
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Kotwal T, Goh S, Bhargava E, Touska P, Possamai V. A Rare Case of Orbital Cellulitis with Progressive Calvarial Osteomyelitis. Glob Pediatr Health 2021; 8:2333794X211042121. [PMID: 34471650 PMCID: PMC8404617 DOI: 10.1177/2333794x211042121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 08/05/2021] [Indexed: 11/17/2022] Open
Abstract
Orbital cellulitis is a potentially sight and life-threatening complication of acute sinusitis, and the association with osteomyelitis is rare in the era of antibiotic-use. A 13-year-old girl presented with coryzal symptoms and severe headache, with a CT head being consistent with a diagnosis of pansinusitis and orbital cellulitis with abscess formation. She proceeded to have surgical drainage through a combined endoscopic and external approach to intraorbital abscess drainage with frontal trephine. She was also diagnosed with progressive calvarial osteomyelitis involving the right frontal bone, treated with a prolonged course of intravenous antibiotics. Our case highlights the importance of a high index of suspicion for complications of sinusitis. Multimodal imaging is essential to establish the extent of infection, and a multi-disciplinary approach is integral to manage this rare complication.
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Affiliation(s)
| | | | | | - Philip Touska
- Guy's and St Thomas NHS Foundation Trust, London, UK
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17
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Fu R, Leader JK, Pradeep T, Shi J, Meng X, Zhang Y, Pu J. Automated delineation of orbital abscess depicted on CT scan using deep learning. Med Phys 2021; 48:3721-3729. [PMID: 33906264 PMCID: PMC8600964 DOI: 10.1002/mp.14907] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 04/06/2021] [Accepted: 04/19/2021] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES To develop and validate a deep learning algorithm to automatically detect and segment an orbital abscess depicted on computed tomography (CT). METHODS We retrospectively collected orbital CT scans acquired on 67 pediatric subjects with a confirmed orbital abscess in the setting of infectious orbital cellulitis. A context-aware convolutional neural network (CA-CNN) was developed and trained to automatically segment orbital abscess. To reduce the requirement for a large dataset, transfer learning was used by leveraging a pre-trained model for CT-based lung segmentation. An ophthalmologist manually delineated orbital abscesses depicted on the CT images. The classical U-Net and the CA-CNN models with and without transfer learning were trained and tested on the collected dataset using the 10-fold cross-validation method. Dice coefficient, Jaccard index, and Hausdorff distance were used as performance metrics to assess the agreement between the computerized and manual segmentations. RESULTS The context-aware U-Net with transfer learning achieved an average Dice coefficient and Jaccard index of 0.78 ± 0.12 and 0.65 ± 0.13, which were consistently higher than the classical U-Net or the context-aware U-Net without transfer learning (P < 0.01). The average differences of the abscess between the computerized results and the experts in terms of volume and Hausdorff distance were 0.10 ± 0.11 mL and 1.94 ± 1.21 mm, respectively. The context-aware U-Net detected all orbital abscess without false positives. CONCLUSIONS The deep learning solution demonstrated promising performance in detecting and segmenting orbital abscesses on CT images in strong agreement with a human observer.
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Affiliation(s)
- Roxana Fu
- Department of Ophthalmology University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Joseph K. Leader
- Departments of Radiology and Bioengineering, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Tejus Pradeep
- Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Junli Shi
- Departments of Radiology and Bioengineering, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Xin Meng
- Departments of Radiology and Bioengineering, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Yanchun Zhang
- Departments of Radiology and Bioengineering, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Jiantao Pu
- Departments of Radiology and Bioengineering, University of Pittsburgh, Pittsburgh, PA 15213, USA
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McCoy JL, Dixit R, Dohar JE, B.J. Tobey A. Pediatric subperiosteal orbital abscess characterization and prediction of size, location, and management. Int J Pediatr Otorhinolaryngol 2021; 144:110693. [PMID: 33813099 PMCID: PMC8087643 DOI: 10.1016/j.ijporl.2021.110693] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/05/2021] [Accepted: 03/24/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Subperiosteal orbital abscess (SPOA) is a serious suppurative complication of pediatric sinusitis. The objective of this study is to stratify patient selection into those best treated medically versus surgically based on clinical outcomes. METHODS This is a retrospective review of patients diagnosed with SPOA complicating sinusitis treated at a tertiary care pediatric hospital from 2002 through 2016. SPOA was diagnosed by CT scan. Characteristics evaluated include demographics, abscess size, location, and measurements, length of hospital stay, medical and surgical interventions, presenting symptoms, and complications. RESULTS A total of 108 total SPOA secondary to sinusitis patients were included. A majority, 72.2%, were male with an average age at presentation of 6.8 years. The mean ± standard deviation abscess cubic volume was 0.98 ± 1.27 cm3 (median(range) = 0.44(0.01-7.34 cmcm3)). With an abscess volume of 0.510 cm3, there was a sensitivity of 71.2% and a specificity of 84.4% for needing surgical drainage. Those with large abscesses at our volume threshold were 13 times more likely to require surgery than those with small abscesses, OR: 13.41, 95%CI: 5.02-35.86, p < .001. Patients that required surgery had an abscess closer to the orbital apex with the majority, 25 (61.0%), being the most proximal to the apex, p = .004. The likelihood of surgery decreased with increased distance from the orbital apex in medial abscesses (OR:.92, 95%CI: 0.86-0.98, p = .009). CONCLUSION In the pediatric population, SPOA is a serious consequence of sinusitis. This study provides evidence supporting that larger abscess size is a significant risk factor for requiring surgery. The appeal of our study is that it provides evidence and support that employ clinical parameters already assessed as standard practice in evaluating these patients. In summarizing the clinical translational relevance of our study, when determining whether to treat a patient with surgery and antimicrobial/medical therapy vs. non-surgical medical therapy alone, the clinician should focus on size of 0.510 cm3 or larger for abscesses in any location as a relative indication for surgery.
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Affiliation(s)
- Jennifer L. McCoy
- Division of Pediatric Otolaryngology, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA
| | - Ronak Dixit
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Joseph E. Dohar
- Division of Pediatric Otolaryngology, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA,Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Allison B.J. Tobey
- Division of Pediatric Otolaryngology, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA,Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA
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19
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Cost comparison between surgical and conservative management for pediatric sinogenic subperiosteal abscesses. Int J Pediatr Otorhinolaryngol 2021; 140:110542. [PMID: 33302023 DOI: 10.1016/j.ijporl.2020.110542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 11/29/2020] [Accepted: 11/29/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND There remains variation in management of orbital complications of acute bacterial rhinosinusitis (ABRS); specifically, those subperiosteal abscesses that present without immediate surgical indication. Recent systematic reviews on management and proposed treatment algorithms are helpful but do not consider the financial implications for healthcare systems and patients. METHODS A retrospective chart review of pediatric patients from a tertiary care children's hospital between 2002 and 2020 was performed, identifying patients via ICD coding corresponding to acute bacterial sinusitis and orbital involvement classified as Chandler 3 confirmed by contrasted computed tomography (CT). Two groups of patients were identified: intravenous (IV) antibiotics alone and IV antibiotics plus surgery. Billing records of total hospital charges and physician fees were recorded for financial analysis. Demographic, length of stay, and charges were analyzed. RESULTS 58 patients with ABRS and Chandler 3 orbital involvement were confirmed by CT imaging. Twenty-nine (50%) were treated with IV antibiotics alone, and twenty-nine (50%) underwent surgery in addition to IV antibiotics. There were no significant differences in patient demographics. The average total hospital charges for the medically managed group were $9262 ± 4831 compared to $30,830 ± 11,397 for the surgical group (p < 0.0001). In the medically managed group, the average hospital fees were $7305 ± 4048 and the average physician fees were $1543 ± 799. In the surgical group, the average hospital and physician fees were also significantly higher at $23,071 ± 7305 (p < 0.0001) and $7763 ± 3335 (p < 0.0001), respectively. Patients who were treated medically and had a longer than average LOS still had significantly fewer charges than those treated with antibiotics plus surgery and a shorter than average length of stay [$15,311 and $27,723, respectively (p = 0.02)]. CONCLUSION Pediatric ABRS with orbital involvement requires prompt attention and management. Controversy persists over subperiosteal abscess management that present without overt surgical indications. Surgical intervention is expensive. Our subgroup analysis demonstrates the magnitude of this cost difference. Specifically, longer inpatient stays with IV antibiotics alone appear to be significantly cheaper than shorter ones that include surgery. Not all Chandler 3 patients are candidates for non-surgical management; however, clinicians are encouraged to keep these data in mind for those patients where further medical management is safe and may yield less expensive clinical resolution.
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Predictors of surgical management for paediatric orbital subperiosteal abscesses. Curr Opin Otolaryngol Head Neck Surg 2020; 28:430-434. [DOI: 10.1097/moo.0000000000000668] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Chorney SR, Elden LM, Giordano T, Kazahaya K, Rizzi MD, Zur KB, Dedhia K. Algorithm-Based Pediatric Otolaryngology Management During the COVID-19 Global Pandemic: A Children’s Hospital of Philadelphia Clinical Consensus. Otolaryngol Head Neck Surg 2020; 163:25-37. [DOI: 10.1177/0194599820923633] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
ObjectiveThe coronavirus disease 2019 (COVID-19) pandemic requires clinicians to explore alternatives to routine patient management. Otolaryngologists caring for children commonly depend on physical examination, laboratory data, and ambulatory surgical procedures. Limiting patient care, mindful allocation of resources, and concern for safety have challenged all aspects of our health care system. This evidence-based clinical consensus is designed to guide practitioners of pediatric otolaryngology for common scenarios during this time.Data SourcesPeer-reviewed literature, published reports, institutional guidelines, and expert consensus.Review MethodsA clinical consensus on 6 common scenarios in pediatric otolaryngology developed with evidence-based strategies.ConclusionsProviders should suspend all in-person nonessential office visits and elective surgical procedures. An emphasis on medical management and caregiver education will provide reasonable approaches to many of the common outpatient concerns. Surgery for chronic otitis media, obstructive sleep apnea, and acute rhinosinusitis should occur only in response to severe complications or failure of medical regimens. The approach to the pediatric neck mass focuses on timely management for oncologic etiologies and cautious surgical intervention for abscess drainage or tissue sampling. Finally, epistaxis and otorrhea must be triaged and addressed without the usual ambulatory procedures.Implications for PracticeAdaptation of practice patterns during this unprecedented moment for our health care system requires thoughtful planning. The strategies described allow for safe handling of common pediatric otolaryngology diagnoses. Ultimately, otolaryngologists must be stewards of our global health community while advocating for the care of individual pediatric patients.
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Affiliation(s)
- Stephen R. Chorney
- Division of Otolaryngology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Otorhinolaryngology–Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lisa M. Elden
- Division of Otolaryngology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Otorhinolaryngology–Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Terri Giordano
- Division of Otolaryngology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Ken Kazahaya
- Division of Otolaryngology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Otorhinolaryngology–Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mark D. Rizzi
- Division of Otolaryngology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Otorhinolaryngology–Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Karen B. Zur
- Division of Otolaryngology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Otorhinolaryngology–Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kavita Dedhia
- Division of Otolaryngology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Otorhinolaryngology–Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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