Tabarino Florian, Elmaleh-Bergès Monique, Quesnel Stéphanie, Lorrot Mathie, Van Den Abbeele Thierry, Teissier Natacha
Pediatric otorhinolaryngology department, Robert Debré Hospital, APHP, Université Paris 7 Denis Diderot, Sorbonne Paris Cité, Paris, France.
Pediatric radiology department, Robert Debré Hospital, APHP, Université Paris 7 Denis Diderot, Sorbonne Paris Cité, Paris, France; University Paris Diderot, Sorbonne Paris Cité, UMRS 1141, F-75019 Paris, France; Inserm, U1141, F-75019 Paris, France.
Int J Pediatr Otorhinolaryngol. 2015 Feb;79(2):131-5. doi: 10.1016/j.ijporl.2014.11.021. Epub 2014 Nov 25.
To investigate predictive factors of surgical management of subperiosteal orbital abscess in children.
A retrospective monocentric study was conducted between 2000 and 2011 with children hospitalized for acute pediatric orbital cellulitis (APOC). Clinical, biological and radiological data as well as medical and surgical management were collected and analyzed. All patients received intravenous antibiotics and underwent a CT-scan. Orbit and subperiosteal intraorbital abscess dimensions were measured on axial and coronal planes and the abscess volume was calculated using a spheroid model.
Eighty-three children with APOC (mean age: 4.5 years) were included, 53 were boys (63.9%). Thirty-two children (38.6%) presented with a subperiosteal orbital abscess. Mean abscess volume was 570mm(3) and mean exophthalmos was 4.7mm. Twenty patients were treated surgically, 11 of which by an endoscopic approach. A positive correlation was observed between the volume of the abscess or exophthalmos and surgical drainage: 57.9% of patients underwent surgery when exophthalmos was >4mm, 29.4% between 2 and 4mm, and none when <2mm. All patients with an abscess volume >500mm(3) or >5% of orbital volume were operated on whereas only 30% or 39% of patients, respectively, in case of smaller volumes (P<0.05).
Surgery for subperiosteal orbital abscess is usually performed in case of visual complications or unfavorable medical outcome. The importance of the exophthalmos and the volume of the abscess measured on the CT-scan are predictive factors of surgery in children with subperiosteal orbital abscess without visual complications.
探讨儿童骨膜下眶脓肿手术治疗的预测因素。
对2000年至2011年期间因急性儿童眶蜂窝织炎（APOC）住院的儿童进行回顾性单中心研究。收集并分析临床、生物学和放射学数据以及药物和手术治疗情况。所有患者均接受静脉抗生素治疗并进行CT扫描。在轴位和冠状位平面上测量眼眶和骨膜下眶内脓肿的尺寸，并使用球体模型计算脓肿体积。
纳入83例APOC患儿（平均年龄：4.5岁），其中53例为男孩（63.9%）。32例患儿（38.6%）出现骨膜下眶脓肿。平均脓肿体积为570mm³，平均眼球突出度为4.7mm。20例患者接受了手术治疗，其中11例采用内镜手术。观察到脓肿体积或眼球突出度与手术引流之间存在正相关：眼球突出度>4mm时，57.9%的患者接受了手术；2至4mm时，29.4%的患者接受了手术；<2mm时，无患者接受手术。所有脓肿体积>500mm³或>眼眶体积5%的患者均接受了手术，而体积较小时分别只有30%或39%的患者接受了手术（P<0.05）。
骨膜下眶脓肿通常在出现视力并发症或药物治疗效果不佳时进行手术。CT扫描测量的眼球突出度和脓肿体积是无视力并发症的儿童骨膜下眶脓肿手术的预测因素。
