Subperiosteal Abscess of the Orbit: Long-term Trends in Bacteriology and Clinical Outcomes and Current Management Recommendations.

Abstract

Purpose: To evaluate the impact over time of evolving upper respiratory pathogens, modified microbial terminology, and improved laboratory isolation on the bacteriology and management of sinusitis-related subperiosteal abscess of the orbit.

Methods: Comparative case series of pediatric patients with bacterial sinusitis-related subperiosteal abscess from 2012 to 2022. Outcomes, culture results, age-specific findings, and antibiotic duration were compared with those in 1977 to 1992, 1988 to 1998, 1999 to 2008, and 2002 to 2012 cohorts at the same institution.

Results: Ninety-one patients met the inclusion criteria. Forty-nine patients (53.8 %) recovered with medical therapy alone; 42 (46.2 %) underwent surgical drainage. There was increased representation in surgical cases of Streptococcus anginosus group (52.4%) and anaerobes (26.2%). Anaerobes were isolated from 2 patients <9 years of age, the youngest age 5; recovery in prior series was limited to patients ≥9 years old. Among 61 of 91 patients <9 years old, 41 (67.2%) were managed medically and 20 (32.8%) underwent surgery. Comparable proportions were 67.5%/32.5%, 85%/15%, and 72%/28% in prior cohorts. Among nonsurgical patients <9 years old, the mean duration of intravenous antibiotics was 4.02 ± 1.2 days. Four patients had multiple admissions. In cases positive for aggressive pathogens, initial findings prompted timely drainage. All patients had favorable visual and systemic outcomes.

Conclusions: This study extends to 45 years a unique analysis of the bacteriology and clinical course of subperiosteal abscess at a single center with comparatively stable patient demographics and environmental factors, using a relatively uniform treatment algorithm. Despite the increased representation of S. anginosus group and anaerobes, a multifactor protocol with minor modifications remains an effective strategy.