Subperiosteal orbital masses in children with orbital cellulitis: time for a reevaluation?

Conflicting reports have arisen in the literature regarding the diagnostic criteria and management of children with a suspected subperiosteal orbital abscess (SOA). To highlight the dilemmas that have arisen a child with a posterior subperiosteal mass, as demonstrated by computerized tomography, is presented. This case and others in the literature suggests a need for better radiographic criteria for distinguishing an SOA from reactive inflammatory edema. Until such criteria are developed, the management of suspected SOA in children should be based principally on clinical signs. Radiographic examinations should be used primarily to rule out the need for surgical intervention.