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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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Voß N, Sadok N, Goretzki S, Dohna-Schwake C, Meyer MF, Mattheis S, Lang S, Stähr K. [Increased rate of complications of pediatric acute otitis media and sinusitis in 2022/2023]. HNO 2024; 72:83-89. [PMID: 38108853 PMCID: PMC10827887 DOI: 10.1007/s00106-023-01393-9] [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] [Accepted: 11/05/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Acute mastoiditis and orbital complications of acute rhinosinusitis are among the most common complications of pediatric infections in otolaryngology. OBJECTIVE The aim of this study was to investigate the frequency of pediatric acute mastoiditis in the setting of acute otitis media as well as pediatric orbital complications in the setting of acute rhinosinusitis. Data from before the pandemic were compared to data after the end of the COVID-19 restrictions. MATERIALS AND METHODS Included were hospitalized children who presented with acute mastoiditis from acute otitis media or with orbital complications from acute rhinosinusitis during the period from April 2017 to March 2023. Compared were three periods using descriptive statistics: April 2017 to March 2020 (before the pandemic in Germany), April 2020 to March 2022 (during the contact restrictions of the pandemic), and April 2022 to March 2023 (after the contact restrictions were lifted). RESULTS A total of 102 children (43 with acute mastoiditis, 42%, and 59 with orbital complications of acute sinusitis, 58%) were included. During the 2022/2023 period, more than twice as many children with acute mastoiditis and approximately three times as many children with orbital complications of acute rhinosinusitis were hospitalized compared to the average of the periods 2017/2018, 2018/2019, and 2019/2020. In the 2021/2022 period, the number of these patients was below the average of previous years. CONCLUSION This year's seasonal cluster of upper respiratory tract infections is associated with a higher-than-average incidence of orbital complications and mastoiditis.
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Affiliation(s)
- Noemi Voß
- Klinik für Hals‑, Nasen‑, Ohrenheilkunde, Universitätsklinikum Essen (AöR), Hufelandstraße 55, 45147, Essen, Deutschland.
| | - Nadia Sadok
- Klinik für Hals‑, Nasen‑, Ohrenheilkunde, Universitätsklinikum Essen (AöR), Hufelandstraße 55, 45147, Essen, Deutschland
| | - Sarah Goretzki
- Zentrum für Kinder- und Jugendmedizin, Universitätsklinikum Essen (AöR), Hufelandstraße 55, 45147, Essen, Deutschland
| | - Christian Dohna-Schwake
- Zentrum für Kinder- und Jugendmedizin, Universitätsklinikum Essen (AöR), Hufelandstraße 55, 45147, Essen, Deutschland
| | - Moritz F Meyer
- Klinik für Hals‑, Nasen‑, Ohrenheilkunde, Universitätsklinikum Essen (AöR), Hufelandstraße 55, 45147, Essen, Deutschland
| | - Stefan Mattheis
- Klinik für Hals‑, Nasen‑, Ohrenheilkunde, Universitätsklinikum Essen (AöR), Hufelandstraße 55, 45147, Essen, Deutschland
| | - Stephan Lang
- Klinik für Hals‑, Nasen‑, Ohrenheilkunde, Universitätsklinikum Essen (AöR), Hufelandstraße 55, 45147, Essen, Deutschland
| | - Kerstin Stähr
- Klinik für Hals‑, Nasen‑, Ohrenheilkunde, Universitätsklinikum Essen (AöR), Hufelandstraße 55, 45147, Essen, Deutschland
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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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Tadros D, Tomoum MO, Shafik HM. Orbital Complications of Chronic Rhinosinusitis: Two Years' Experience in a Tertiary Referral Hospital. Ocul Immunol Inflamm 2023; 31:292-297. [PMID: 35050844 DOI: 10.1080/09273948.2022.2026415] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE To investigate the different clinical manifestations in Egyptian patients with orbital complications of rhinosinusitis (RS) according to the pathology within the paranasal sinuses. METHODS The medical records of patients presented with chronic RS between August 2018 and December 2020 were retrospectively reviewed. RESULTS This study included 64 patients: 28 patients with subperiosteal abscess (SPA), 10 with allergic fungal RS, 6 with isolated fungal RS, 6 with invasive fungal RS, and 14 with mucocele. The most common manifestation was proptosis, limitation of ocular motility, periorbital swelling, and pain. A relative afferent pupillary defect was present in all cases of invasive fungal sinusitis. Surgical interventions were performed in 63 out of 64 cases. All the ophthalmological manifestations were reversible except for patients with invasive fungal rhinosinusitis. CONCLUSION Orbital complications of RS may require early surgical intervention with multidisciplinary counseling between ophthalmologists, otorhinolaryngologists, radiologists, and neurologists.
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Affiliation(s)
- Dina Tadros
- Department of Ophthalmology, Faculty of Medicine, University of Tanta, Tanta, Egypt
| | - Mohamed O Tomoum
- Department of Otorhinolaryngology, Faculty of Medicine, University of Tanta, Tanta, Egypt
| | - Heba M Shafik
- Department of Ophthalmology, Faculty of Medicine, University of Tanta, Tanta, Egypt
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Clinical Markers of Need for Surgery in Orbital Complication of Acute Rhinosinusitis in Children: Overview and Systematic Review. J Pers Med 2022; 12:jpm12091527. [PMID: 36143312 PMCID: PMC9504785 DOI: 10.3390/jpm12091527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/09/2022] [Accepted: 09/13/2022] [Indexed: 11/22/2022] Open
Abstract
Background: Although they can occur at all ages, orbital (OC) and periorbital cellulitis (POC) prevail in the pediatric population. Acute rhinosinusitis (ARS) is the most frequent predisposing factor of OC. Recent literature has suggested a medical management approach for OC and POC, with surgery reserved only for more severe cases. However, there is still a lack of consensus on the clinical markers of a need for surgery. The aim of this systematic review was to identify clinical markers of a need for surgery in children with OC. Our systematic review, in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) process, yielded 1289 articles finally screened. This resulted in 31 full texts that were included in a qualitative analysis. The results of this review suggest that in children aged over 9 years, large subperiosteal orbital abscesses (SPOAs), impaired vision, ophthalmoplegia, proptosis, elevated C-reactive protein (CRP) and absolute neutrophil counts (ANC), hemodynamic compromise, no clinical improvement after 48/72 h of antibiotic therapy, and a Chandler III score or higher are clinical markers of the need for surgery. However, most of the studies are observational and retrospective, and further studies are needed to identify reliable and repeatable clinical markers of the need for surgery.
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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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Martins M, Martins SP, Pinto-Moura C, Leal V, Spratley J. Management of post-septal complications of acute rhinosinusitis in children: A 14-year experience in a tertiary hospital. Int J Pediatr Otorhinolaryngol 2021; 151:110925. [PMID: 34597875 DOI: 10.1016/j.ijporl.2021.110925] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 08/17/2021] [Accepted: 09/18/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Acute rhinosinusitis accounts for most of the cases of orbital infections and is the most common cause of periorbital oedema in children. Up to 10% of patients with orbital complications of acute rhinosinusitis may experience vision loss and other complications such as meningitis, intracranial abscess or even death. Therefore, these patients require prompt diagnosis and proper treatment. OBJECTIVES This study aims to report the clinical presentation and management of post-septal orbital complications of acute rhinosinusitis in the paediatric population. MATERIALS AND METHODS A retrospective medical chart review of all children aged under 18 years old who were diagnosed with post-septal orbital complications of acute rhinosinusitis at a tertiary academic hospital, between 01/2007 and 12/2020. Patients were grouped according to the Chandler Classification (groups 2-5). RESULTS Fifty-five children (mean age of 6.91 ± 4.61 years) fulfilled the entry criteria for post-septal orbital complications of acute rhinosinusitis, based on clinical evaluation by an otorhinolaryngologist and CT-scan findings. Forty (72.72%) patients were also evaluated by an ophthalmologist. Most patients were male (76.36%). Twenty-four patients had post-septal cellulitis (43.63%), 21 patients had a subperiosteal abscess (38.18%) and 10 patients had an orbital abscess (18.18%). Eyelid swelling was the most frequent sign, followed by fever. Microbiology varied considerably and gram-positive agents were clearly predominant. Eighteen (32.73%) patients had been treated with oral antibiotics prior to hospital admission, exhibiting a significantly higher risk of recurrence of orbital infection (p = 0.020). Ethmoid and maxillary sinuses were the most involved paranasal sinuses (90.91%). Thirty-three patients (60%) were successfully treated medically, and 22 patients (40%) required surgical drainage. Seven patients (12.73%) developed further complications and six recovered without sequelae. The mean length of hospital stay was 8.0 ± 5.0 days and recurrence of orbital infection occurred in six patients (10.91%). The absolute neutrophil blood count was significantly different amongst Chandler groups (p = 0.021), with higher counts in patients with subperiosteal abscess. The duration of hospitalization was significantly higher in patients submitted to surgery (p < 0.001). CONCLUSION Post-septal orbital complications of acute rhinosinusitis are infrequent but dangerous events in the paediatric population. Close collaboration with Ophtalmology is paramount, as the child's vision is at risk. Eyelid swelling and proptosis are early signs. CT-scan imaging plays an invaluable role in the diagnosis and decision-making. Predictive indicators for surgery were not found. However, emergency endoscopic nasal surgery with abscess drainage should be considered whenever vision is at risk, if there is no improvement after aggressive medical treatment, and in cases of intracranial complications.
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Affiliation(s)
- Manuel Martins
- Unit of Otorhinolaryngology, Department of Surgery & Physiology, University of Porto Faculty of Medicine, Porto, Portugal.
| | - Sónia Pires Martins
- Unit of Otorhinolaryngology, Department of Surgery & Physiology, University of Porto Faculty of Medicine, Porto, Portugal; Department of Otorhinolaryngology, University Hospital S. João Centre, E.P.E., Porto, Portugal.
| | - Carla Pinto-Moura
- Department of Otorhinolaryngology, University Hospital S. João Centre, E.P.E., Porto, Portugal; Department of Genetics, University Hospital S. João Centre, Faculty of Medicine of University of Oporto, Portugal; I3S, Institute Research and Innovation Health, University of Oporto, Portugal.
| | - Vitor Leal
- Department of Ophtalmology, University Hospital S. João Centre, E.P.E., Porto, Portugal.
| | - Jorge Spratley
- Unit of Otorhinolaryngology, Department of Surgery & Physiology, University of Porto Faculty of Medicine, Porto, Portugal; Department of Otorhinolaryngology, University Hospital S. João Centre, E.P.E., Porto, Portugal; Centre for Health Technology and Services Research (CINTESIS), Porto, Portugal.
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