Gibbons Alison B, Van Brummen Alexandra, Bacorn Colin, Niknahad Ava, Chang Shu-Hong, Jian-Amadi Arash, Chambers Christopher, Zhang Matthew, Li Emily
Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Department of Ophthalmology, University of Washington School of Medicine, Seattle, Washington, USA.
Orbit. 2024 Dec;43(6):695-704. doi: 10.1080/01676830.2024.2355650. Epub 2024 May 30.
The aim of this study was to assess predictors and outcomes of subperiosteal abscess (SPA) management in adolescents and adults at two tertiary care centers.
This retrospective cohort study included cases of SPA from January 1 2000 to October 9 2022 at two institutions. Patients 9 years or older were categorized into surgical and nonsurgical cohorts. Surgical subgroups included those who underwent functional endoscopic sinus surgery (FESS) alone, external (transcutaneous or transconjunctival) orbitotomy alone, or combined FESS and external surgery. The presented features were assessed as potential treatment predictors. Outcomes included length of stay (LOS), final best-corrected visual acuity (BCVA), readmission rate, and reoperation rate.
Of the 159 SPA cases included, 127 (79.9%) underwent surgery and 32 (20.1%) were managed nonsurgically. The nonsurgical cohort was younger ( = .003) with smaller abscesses ( < .001) that were more likely to be medial ( < .001). The nonsurgical cohort had shorter LOS ( < .001); final BCVA and readmission rates were similarly favorable. Abscess location was correlated with surgical approach. Superior SPA that underwent FESS or external surgery alone had higher reoperation rates (57.1.0% and 58.3%, respectively) than combined (17.9%). External approach and FESS alone resulted in lower reoperation rates (15.4% and 15.0%, respectively) than combined (27.3%) for medial SPA. Subgroup analysis in the sinusitis cohort yielded similar results.
A trial of nonsurgical management may be safe and effective for select patients aged 9 years and older with sinusitis-derived, medial, and small SPA. When surgery is indicated, approach should be guided by abscess location to minimize reoperation risk.
本研究旨在评估两家三级医疗中心青少年和成人骨膜下脓肿（SPA）治疗的预测因素和结果。
这项回顾性队列研究纳入了2000年1月1日至2022年10月9日两家机构的SPA病例。9岁及以上患者分为手术组和非手术组。手术亚组包括仅接受功能性鼻内镜鼻窦手术（FESS）、仅接受外部（经皮或经结膜）眶切开术或接受FESS与外部手术联合治疗的患者。所呈现的特征被评估为潜在的治疗预测因素。结果包括住院时间（LOS）、最终最佳矫正视力（BCVA）、再入院率和再次手术率。
在纳入的159例SPA病例中，127例（79.9%）接受了手术治疗，32例（20.1%）接受了非手术治疗。非手术组患者年龄更小（P = 0.003），脓肿更小（P < 0.001），且更可能位于内侧（P < 0.001）。非手术组的住院时间更短（P < 0.001）；最终BCVA和再入院率同样良好。脓肿位置与手术方式相关。单独接受FESS或外部手术的上颌窦SPA再手术率（分别为57.1%和58.3%）高于联合手术（17.9%）。对于内侧SPA，单独的外部手术和FESS导致的再手术率（分别为15.4%和15.0%）低于联合手术（27.3%）。鼻窦炎队列的亚组分析得出了类似结果。
对于部分9岁及以上患有鼻窦炎源性、内侧和小面积SPA的患者，非手术治疗试验可能是安全有效的。当需要手术时，手术方式应根据脓肿位置进行指导，以降低再次手术风险。
