Jabarin Basel, Eviatar Ephraim, Israel Ofer, Marom Tal, Gavriel Haim
Department of Otolaryngology-Head and Neck Surgery, Assaf Harofeh Medical Center, Tel Aviv University Sackler School of Medicine, 70300, Zerifin, Israel.
Eur Arch Otorhinolaryngol. 2018 Apr;275(4):943-948. doi: 10.1007/s00405-018-4897-4. Epub 2018 Feb 15.
Our objective was to identify the clinical indicators for subperiosteal orbital abscess (SPOA) among patients who present with periorbital cellulitis secondary to rhinosinusitis, and to evaluate the need for performing a computerized tomography (CT) scan.
A retrospective cohort study of all patients admitted to our tertiary care emergency department between 2006 and 2014 was conducted. Included were healthy patients with acute periorbital cellulitis secondary to rhinosinusitis. Variables analyzed included age, gender, duration of symptoms, previous antibiotic therapy, highest recorded temperature, physical examination findings, ophthalmologist's examination results, laboratory results, and interpretation of imaging studies, when performed.
Of the 123 identified patients, 78 (63%) were males, with a mean age of 4 years (range 1-70). 68 patients were categorized as Chandler's 1 disease, 2 as Chandler's 2, and 53 as Chandler's 3. 68 patients underwent a CT scan, of those 53 had SPOA. Proptosis and ophthalmoplegia were strongly associated with the presence of an abscess (P < 0.001). However, 14 patients with no ophthalmoplegia or proptosis who underwent a CT scan were older (mean age, 10 years; P < 0.028), and had higher neutrophil count of 78 versus 59% (P = 0.01). This group of patients had a clinically rapidly progressive disease, receiving wider broad-spectrum antibiotics or had their antibiotic treatment replaced to broader spectrum antibiotics through their course of treatment (48.2% compared to only 6.1%).
We confirmed that patients with proptosis and/or limitation of extraocular movements are at high risk for developing SPOA, yet many do not have these predictors. Other features can identify patients who do not have proptosis and/or limitation of extraocular movements but do have significant risk of SPOA, and in these cases performing an imaging study is strongly suggested.
我们的目标是在因鼻窦炎继发眶周蜂窝织炎就诊的患者中确定骨膜下眶脓肿（SPOA）的临床指标，并评估进行计算机断层扫描（CT）的必要性。
对2006年至2014年间入住我们三级医疗急诊科的所有患者进行回顾性队列研究。纳入的患者为因鼻窦炎继发急性眶周蜂窝织炎的健康患者。分析的变量包括年龄、性别、症状持续时间、既往抗生素治疗情况、最高体温记录、体格检查结果、眼科医生检查结果、实验室检查结果以及影像学检查结果（如有）。
在123例确诊患者中，78例（63%）为男性，平均年龄4岁（范围1 - 70岁）。68例患者归类为钱德勒1型疾病，2例为钱德勒2型，53例为钱德勒3型。68例患者接受了CT扫描，其中53例患有SPOA。眼球突出和眼球运动受限与脓肿的存在密切相关（P < 0.001）。然而，14例未出现眼球运动受限或眼球突出但接受了CT扫描的患者年龄较大（平均年龄10岁；P < 0.028），中性粒细胞计数较高，分别为78%和59%（P = 0.01）。这组患者临床疾病进展迅速，接受了更广泛的广谱抗生素治疗，或在治疗过程中将抗生素治疗更换为更广谱的抗生素（48.2%，而仅6.1%）。
我们证实，眼球突出和/或眼球运动受限的患者发生SPOA的风险较高，但许多患者没有这些预测指标。其他特征可识别出虽无眼球突出和/或眼球运动受限但发生SPOA风险较高的患者，在这些情况下，强烈建议进行影像学检查。
