Orbital subperiosteal abscess secondary to osteomyelitis in a patient with chronic sinusitis

Objective@#To report a case of orbital subperiosteal abscess in a diabetic elderly patient.@*Methods@#This is a case report.@*Results@#A 65-year-old diabetic female consulted for a two-month history of poor vision on both eyes and a palpable mass on the left brow area. The patient previously underwent functional endoscopic sinus surgery and was treated for postoperative systemic infection and several complications including sinusitis, mastoiditis, trigeminal neuralgia, bacterial meningitis, and otitis media. On presentation, best-corrected visual acuity was noted to be no light perception on the right eye and 20/400 on the left eye. She had a relative afferent pupillary defect on the right eye, ophthalmoplegia on both eyes, and inferior displacement and proptosis of the left globe. Magnetic resonance imaging showed subperiosteal abscess on the left superior orbital rim with intraorbital extension. The patient underwent surgery and the culture from the drained abscess yielded Pseudomonas aeruginosa and Enterobacter cloacae. Pathologic examination of the orbital bone sample revealed osteomyelitis.@*Conclusion@#Osteomyelitis of the orbital bone leading to subperiosteal abscess is a complex, multifactorial disease requiring rapid diagnosis and treatment. Complete resolution of the infection must be achieved to decrease the morbidity and mortality of the patient.

Orbital Cellulitis In A Pediatric Population - Experience From A Tertiary Center

Objective: To describe our experience in treating children afflicted with orbital cellulitis. Methods: A retrospective analysis of hospital records of children afflicted with orbital cellulitis was conducted between 2005-2018. Clinical, laboratory and radiology characteristics as well as management, microbiological data, and outcomes were collected. Results: Of the 94 patients, painful restriction of ocular motility was observed in 37.2% and proptosis in 34%, whereas, only 18% of the children presented with both classical signs. Children aged older than 9 years presented with markedly elevated inflammatory markers i.e., leukocytosis and C-reactive protein (CRP). Only a minority (12, 12.4%) required functional endoscopic sinus surgery. Conclusion: Our data support the general approach that orbital cellulitis should be initially managed conservatively with close monitoring; since, only a minority of patients require surgical intervention.

Orbital cellulitis: early intervention saves vision

Orbital cellulitis describes an infection involving the soft tissues posterior to the orbital septum including the fat and muscle within the bony orbit. This condition is associated with severe sight and life-threatening complications. Distinguishing it from preseptal cellulitis is difficult, but important. Acute sinusitis is the commonest predisposing factor. Clinical findings alone are not specific enough to distinguish between preseptal and post septal orbital cellulitis. Early diagnosis using CT orbit is important to rule out complications such as orbital cellulitis, subperiosteal abscess. The most common location of subperiosteal abscess is the medial wall of the orbit. Transnasal endoscopic drainage of the abscess is a functional and minimally invasive technique and is the treatment of choice at present. Early diagnosis and intervention are mandatory to prevent the visual loss and life-threatening complication.Here, the authors describe a 2 months old infant with orbital cellulitis and medial subperiosteal abscess and treated with transnasal endoscopic drainage of the subperiosteal abscess.

Celulitis orbitaria complicada por absceso subperióstico debido a infección por Streptococcus pyogenes / Orbital cellulitis complicated by subperiosteal abscess due to Streptococcus pyogenes infection

Resumen: Introducción: La celulitis orbitaria es una enfermedad infecciosa muy frecuente en la edad pediátrica que puede provocar el desarrollo de severas complicaciones. Los principales microorganismos involucrados son Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae y Moraxella catarrhalis, que juntos corresponden al 95% de los casos. También se pueden presentar Streptococcus beta hemolíticos y microorganismos anaerobios, que corresponden a menos del 5% de los casos. Se presenta un caso poco frecuente de celulitis orbitaria complicada por absceso subperióstico ocasionado por Streptococcus pyogenes (estreptococo beta hemolítico del grupo A). Caso clínico: Paciente masculino de 9 años de edad con antecedente de trastorno por déficit de atención e hiperactividad desde los 5 años de edad. Inició su padecimiento actual por presentar eritema en canto externo del ojo derecho; posteriormente, aumento de volumen periorbicular con limitación de apertura palpebral, progresión a proptosis, dolor a los movimientos oculares y secreción conjuntival purulenta. Los estudios de imagen subperióstico reportaron absceso y preseptal derecho con celulitis extraocular. Se inició manejo empírico con antibióticos, drenaje quirúrgico y cultivo del material purulento. De este, se aisló Streptococcus pyogenes. Conclusiones: Debido a la implementación de los esquemas de vacunación desde la década de los 90 contra H. influenza y S. pneumoniae, los casos por estos patógenos han disminuido, provocando que nuevas bacterias tomen su lugar como causantes de la infección. La importancia de considerar a S. pyogenes como etiología de celulitis orbitaria radica en la rápida progresión para la formación de abscesos, así como los pocos casos descritos en la literatura.

Abstract: Background: Orbital cellulitis is an infectious disease that is very common in pediatric patients, in which severe complications may develop. Etiological agents related to this disease are Haemophilus influenzae B, Staphylococcus aureus, Streptococcus pneumoniae and Moraxella catarrhalis, which correspond to 95% of cases. Moreover, Streptococcus beta hemolytic and anaerobic microorganisms may also be present corresponding to < 5% of the cases. We present an uncommon case of cellulitis complicated by sub-periosteal abscess caused by Streptococcus pyogenes (Group A beta hemolytic streptococcus). Case report: A 9-year-old male patient with a history of deficit disorder and hyperactivity since 5 years of age. His current condition started with erythema in the external edge of the right eye, increase in peri-orbicular volume with limitation of eyelid opening, progression to proptosis, pain with eye movements and conjunctival purulent discharge. Image studies reported subperiosteal abscess and preseptal right with extraocular cellulitis. The patient started with empirical antibiotic treatment, surgical drainage and culture of purulent material from which Streptococcus pyogenes was isolated. Conclusions: Due to the implementation of vaccination schemes against H. influenza and S. pneumoniae since the 90s, the cases by these pathogens have decreased, causing new bacteria to take place as the cause of the infection. The importance of considering S. pyogenes as an etiology of orbital cellulitis is the rapid progression to abscess formation, and the few cases described in the literature.

Case Report: Progression of Pre-Septal Cellulitis to Orbital Subperiosteal Abscess despite Intravenous Broad-Spectrum Antibiotics in a Child

We report a case of a 7-year-old girl who initially presented with painless right eyelid swelling with full extra-ocular movement (EOM). She was treated with intravenous broad-spectrum antibiotics for preseptal cellulitis but her condition worsened. An urgent magnetic resonance imaging (MRI) of the brain and orbit showed orbital abscess, subperiosteal abscess in the medial orbital wall and evidence of sinusitis in the anterior ethmoidal air cells. She underwent Endoscopic Orbital Decompression (EOD) surgery on day 4 of presentation and her condition improved remarkably. We report a case of orbital abscess with subperiosteal abscess in the medial orbital wall. This case highlights the possibility of progression of orbital cellulitis despite administration of a broad-spectrum antibiotic.

Two Cases of Acute Mastoiditis with Subperiosteal Abscess

The incidence of mastoiditis in pediatric age has consistently increased over the last two decades due to increase of antibiotic-resistant bacteria. Compared to young patients, occurrence of acute otitis media complications such as acute mastoiditis and subperiosteal abscess is relatively low in adults. Various treatments for acute mastoiditis with subperiosteal abscess such as tympanostomy tube insertion, intravenous antibiotics, and postauricular incision and drainage have avoided the morbidity and necessity of mastoid surgery. Recently, many studies have indicated mastoidectomy only in cases of severe complications or failure of disease improvement after antibiotic treatment and myringotomy. In this report, we present two cases of successful treatment of subperiosteal abscess and discuss the management of acute mastoiditis with subperiosteal abscess in both child and adult.

Simultaneous Subperiosteal and Subdural Abscesses Occurred as Complications of Acute Sinusitis

Acute sinusitis is a common medical problem which can result in serious complications if it is not managed appropriately. The most common complication of acute sinusitis is orbital complication, followed by intracranial complications. Concomitant involvement of the orbit and the brain as complications of acute sinusitis is very rare. We were presented with a case of a 27-year-old woman who suffered from subperiosteal abscess in the orbit and subdural abscess in the frontal area. Endoscopic sinus surgery, drainage of the subperiosteal abscess through eyebrow incision and drainage of the subdural abscess through craniotomy were performed. The postoperative course was uneventful, and the patient was free of ocular and neurologic symptoms at the eight month follow-up.

Orbital Cellulitis With Subperisoteal Abscess Secondary to Dental Extraction

PURPOSE: We report a case of orbital cellulitis with subperiosteal abscess secondary to dental extraction. CASE SUMMARY: A 55-year-old man presented to the emergency department with severe erythematous, painful swelling of the left periorbital area and the upper cheek after extraction of the left maxillary molar and premolar teeth. Computed tomography scan demonstrated marked periorbital inflammation and medial displacement of the left lateral rectus muscle by subperiosteal abscess extending along the lateral orbital wall. After a 10-day course of intravenous broad spectrum antibiotics and a 7-day course of oral prednisolone, he achieved complete resolution of all clinical symptoms and signs. CONCLUSIONS: Physicians should keep in mind that orbital complications may occur after oral surgery. A high level of suspicion in a patient with preceptal signs and a history of recent tooth infection or extraction is needed to avoid missing a diagnosis.

Superior Orbital Subperiosteal Abscess due to Infected Mucocele: A Case Report and Review of the Literature / 대한이비인후과학회지

Subperiosteal abscess is one of the most common orbital complications of acute sinusitis. It can result in significant morbidity if not appropriately managed. Mucoceles of the paranasal sinuses are chronic lesions containing inspissated mucus, which occurs when sinus ostium is obstructed. A 64-year-old woman was presented with infected mucocele and subperiosteal abscess located in the superior wall of orbit simultaneously. The infected ethmoid mucocele was treated by endoscopic surgery but subperiosteal abscess was managed by traditional external approach because it was difficult to treat with endoscopic surgical approach.

Effect of Corticosteroids in the Treatment of Orbital Cellulitis with Subperiosteal Abscess

PURPOSE: To investigate the effect of corticosteroids in the treatment of orbital cellulites with subperiosteal abscess. METHODS: The medical records of 4 patients treated for orbital cellulitis with subperiosteal orbital abscess were reviewed. The class and dose of corticosteroids, surgical drainage, treatment course and clinical outcomes were reviewed. RESULTS: All patients received corticosteroids showed satisfactory results during 4.5 months of average follow up. Only one patient have been decreased visual acuity. Complications were minimal including mild hypokalemia, increased hepatic enzyme including aspartate aminotransferase and alanine aminotransferase. CONCLUSIONS: The use of corticosteroids may be beneficial in the treatment of orbital cellulitis with subperiosteal abscess.

Clinical Analysis of Orbital Subperiosteal Abscess

BACKGROUND AND OBJECTIVES: Subperiosteal abscess is one of the most common orbital complications of sinusitis. It occurs secondary to the spread of infection through natural dehesience of orbital wall, bony suture line, and vein. One of serious complications of subperiosteal abscess is permanently decreased visual acuity, and its incidence is reported as 15-30%. The purpose of this study is to assess the clinical features, diagnosis, management, and therapeutic results. MATERIALS AND METHODS: We reviewd retrospectively the medical records of 7 patients with subperiosteal abscess for recent 13 years. Patients were 5 males and 2 females, and the age of patients ranged from 4 to 64 years. RESULTS: 3 cases of subperiosteal abscesses developed in medial wall, 3 cases in superior wall and 1 case in inferior wall. We did successful surgical drainage in 5 patients and 2 cases were treated with intravenous antibiotics only. In case of medial and inferior wall, drainage procedure was done safely by endoscopic sinus surgery. However, in case of superior wall, traditional external approach was used. CONCLUSION: Exact ophthalmologic evaluation and CT finding are important in determinig surgical treatment. Furtehrmore, method of surgical approach depends on the sites of subperiosteal abscess.

Treatment of Subperiosteal Abscess of the Orbit in Children

PURPOSE: The subperiosteal abscess in the orbit, caused mostly by sinusitis, has the major clinical finidings such as lid swelling, proptosis, limitation of the eye movement, and so on. The combined systemic administration of antibiotics and surgical drainage are the cornerstone of the treatment for the subperiosteal abscess. However, recent studies have shown that the systemic antibiotic therapy without any surgical intervention can effectively treat the disease. Therefore, this paper presents the case studies based on the treatment results of subperiosteal abscess. METHODS: The medical files of six patients are reviewed in detail, focused on the clinical findings and treatment results. The subjects had the subperiosteal abscess in the orbit and treated from June 1, 1996 to July 31, 2001. RESULTS: Five out of six patients were under the age of fifteen; 2 in the nasal side, 2 in the inferior side, and 1 in the superior side of the orbit. All of the five patients were treated effectively by the intravenous antibiotic therapy only. CONCLUSIONS: The subperiosteal abscess of the orbit in pediatric patients was treated by the intravenous antibiotic therapy only, including the one in the superior side. It is suggested that the intravenous antibiotic therapy can be enough to treat the subperiosteal abscess. However, we also recommend close monitoring of the patients to see whether the surgical intervention might be needed or not.

Orbital subperiosteal abscess secondary to odontogenic infection of lower molar: a case report

A Case of Primary Tuberculous Otitis Media with Lateral SinusThrombosis and Subperiosteal Abscess / 대한이비인후과학회지

Tuberculosis of the middle ear is a disease rarely encountered in recent years. Because what used to be the typical clinical signs of this disease have been changed in recent years and the index of suspicion being low, there is frequently a considerable delay prior to diagnosis. This can lead to irreversible complications. A case of tuberculous otitis media complicated with lateral sinus thrombosis and subperiosteal abscess is reported with review of the literature, emphasizing the fact that this entity must be considered in the differential diagnosis of persistent suppurative otitis media.

A Case of Orbital Subperiosteal Abscess Associated with Acute Paranasal Sinusitis after Trauma

Although orbital abscess is seen in all age, it is found predominantly in children 16 years of age or less. It may result from orbital trauma, foreign body, inflammation and direct spillage or hematogenous extension of bacteria from sinuses to orbit. The authors experienced a 8-year-old male patient who presented with proptosis, decreased visual acuity, and limitation of eyeball movement on left eye after injury by soccer ball. Orbital subperiosteal abscess or orbital rhabdomyosarcoma were suspected, and the patient was operated for biopsy and removal of mass. Subperiosteal abscess was found below frontal bone during exploration, and incisional drainage and massive irrigation was done. At postoperative seventh day, visual acuity of the patient was 20/20, proptosis was markedly decreased and eyeball movement was normal. The authors experienced a case of orbital subperiosteal abscess associated with acute paranasal sinusitis after trauma, and a good result was obtained following surgical draining.

Two Cases of Acute Coalescent Mastoiditis Complicated by Subperiosteal Abscess / 대한이비인후과학회지

In the era of antibiotics, acute coalescent mastoiditis is a very uncommon event, but remains a potentially serious condition. Significant and even life-threatening complications beyond the tympanomastoid space may occur, including periauricular subperiosteal abscess, facial paralysis, meningitis, brain abscess, etc. However, there have appeared a few papers in the recent Korean literature on acute coalescent mastoiditis. Recently, we encountered with two cases of acute coalescent mastoidtitis complicated by subperiosteal abscess. Including incision and drainage of the abscess, parenteral antibiotic therapy was done for several days until the acute stage of infection was controlled. After that, simple mastoidectomy with ventilation tube insertion was carried out. We report these cases with review of literature.

Postauricular Subperiosteal and Bezold's Abscesses Complicating Chronic Suppurative Otitis Media with Cholesteatoma / 대한이비인후과학회지

Subperiosteal abscess of the mastoid region and Bezold's abscesses have become very rare since introduction of antibiotics. Subpriosteal abscess is usually seen in children who have acute mastoiditis. Its occurrence in adults or in associated with chronic otitis media is even more unusual. Bezold's abscess, a complication of acute otitis media in adult who has well pneumatized air cells in the tip of the mastoid, is also rarely seen in the current era of antibiotics. This paper reports a case of postauricular subperiosteal and Bezold's abscess complicating chronic suppurative otitis media with cholesteatoma in a 37-year old woman with review of literatures.