Medical versus surgical management of pediatric orbital subperiosteal abscesses.

BACKGROUND Orbital subperiosteal abscess (SPA) describes a process in which a collection of pus forms between the bony orbit and the periorbita. SPA most commonly arises as a complication of acute sinusitis, where it exists along a spectrum of orbital involvement from limited (preseptal cellulitis) to severe (cavernous sinus thrombosis). The surgical management of SPA in children has evolved from drainage via an external approach to an endoscopic approach. Controversy remains, however, in deciding which SPAs require drainage, and which may be managed conservatively with systemic antibiotics.