Surgical treatment of subperiosteal orbital abscess.

OBJECTIVE To determine the factors influencing the surgical approach to a pediatric subperiosteal orbital abscess (PSPOA), more specifically, comparing external (E) vs transnasal endoscopic (TNE) surgical approaches. DESIGN A retrospective medical chart review. SETTING Children's National Medical Center in Washington, DC. PATIENTS All pediatric patients who underwent surgical treatment of PSPOA from 2004 to 2007. MAIN OUTCOME MEASURES Age at presentation, presentation duration of periorbital edema before presentation, white blood cell count and temperature at initial presentation, preoperative radiographic location of abscess, and number of extraocular muscles displaying radiographic abnormalities. RESULTS Thirteen patients, 10 boys and 3 girls, were identified (mean age, 8.7 years [range, 6 weeks to 13 years]). Five patients were successfully treated with only a TNE approach, whereas 8 patients required an E approach. Location of PSPOAs and radiographic changes of extraocular muscles differentiated the patients in TNE and E groups. All patients had eventual resolution of their disease without any surgical complications. CONCLUSIONS Factors influencing the choice of surgical approach for the treatment of PSPOAs extend beyond surgeon preference. Patient clinical presentation and radiographic findings may help guide the physician in choosing an appropriate surgical approach.