Abstract
Objectives
Orbital cellulitis (OC) represents a group of conditions ranging from periorbital inflammation to subperiosteal/orbital abscess (SPOA) and cavernous sinus thrombosis. Improvements in imaging studies and endoscopic techniques have led to continued controversies regarding the medical and surgical management of these. We sought to clarify this by reviewing our experience with patients admitted to our institution with OC during a 6-year period.
Methods
465 admissions with a diagnosis of OC were identified in the last 6 years. Charts were reviewed for presentation, radiologic evaluation, medical management, surgical treatment, and outcome.
Results
Of the 465 patients, 189 were treated in the emergency room and 276 were admitted to the hospital. CT scan was performed on 240 patients. Subperiosteal or orbital abscess was noted in 70 patients. Of these, 47 were treated medically and 23 had surgery. Surgery was performed endoscopically in 7 patients, open in 9 patients, through a combined approach in 6 patients, and was not documented in 1 case. Patients treated surgically were older (8.5 vs. 6.2 years, p=0.018) and had a longer hospital course (11.3 vs. 6.6 days, p=0.002) than those treated medically. WBC count on admission was similar between groups. Patients with large abscesses, defined as greater than 10mm, were more likely to require surgical intervention than patients with small abscesses (Greek chi 2, p<0.001).
Conclusions
Small SPOA in younger children can successfully be treated medically, while older patients with larger abscesses are more likely to require surgical intervention, in many cases through an open approach.
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