João Laffont1, Sandra Augusto1, Lígia Cardoso2, João Carlos Ribeiro1* and Antonio Paiva1
Abstract:
Introduction: The incidence of orbital subperiosteal abscess (OSA) in pediatric population is 15% of the orbital infections, being acute sinusitis the most frequent cause of this complication. The diagnosis of OSA is based on clinical examination and imaging. Treatment usually includes IV antibiotics, nasal decongestants and surgical drainage if necessary. If inadequately treated, orbital cellulitis may progress to intracranial complications, blindness and even death.
Case presentation: A 10 year old child, presented with left palpebral edema with eye proptosis, ocular pain, gaze restriction, diplopia, conjunctival hyperemia and headache following three days of fever and URTI. CT imaging revealed pansinusitis with left OSA of the medial wall, compressing the eye globe with anterior-lateral deviation and exophthalmia. Functional endoscopic sinus surgery (FESS) decompression was performed after 48h of medical treatment without improvement. Ophthalmology examination improved dramatically the day after surgery. Patient was discharged completely asymptomatic after 8 days with a normal visual function after 2 years of follow-up.
Conclusion: When managing OSA, an early diagnosis and adequate infection control is of upmost importance. CT orbital scan is a reliable diagnostic method and initial IV antibiotic therapy may be possible. As demonstrated in this case report, if surgical approach of a medial OSA is necessary, FESS is a valid, adequate and effective solution at short and long term.
Introduction: The incidence of orbital subperiosteal abscess (OSA) in pediatric population is 15% of the orbital infections, being acute sinusitis the most frequent cause of this complication. The diagnosis of OSA is based on clinical examination and imaging. Treatment usually includes IV antibiotics, nasal decongestants and surgical drainage if necessary. If inadequately treated, orbital cellulitis may progress to intracranial complications, blindness and even death.
Case presentation: A 10 year old child, presented with left palpebral edema with eye proptosis, ocular pain, gaze restriction, diplopia, conjunctival hyperemia and headache following three days of fever and URTI. CT imaging revealed pansinusitis with left OSA of the medial wall, compressing the eye globe with anterior-lateral deviation and exophthalmia. Functional endoscopic sinus surgery (FESS) decompression was performed after 48h of medical treatment without improvement. Ophthalmology examination improved dramatically the day after surgery. Patient was discharged completely asymptomatic after 8 days with a normal visual function after 2 years of follow-up.
Conclusion: When managing OSA, an early diagnosis and adequate infection control is of upmost importance. CT orbital scan is a reliable diagnostic method and initial IV antibiotic therapy may be possible. As demonstrated in this case report, if surgical approach of a medial OSA is necessary, FESS is a valid, adequate and effective solution at short and long term.
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