Department of Otolaryngology - Head and Neck Surgery, College of Medicine, King Saud University , Riyadh, Saudi Arabia.
Otolaryngology - Head & Neck Surgery Department, King Saud University Medical City, Riyadh, Saudi Arabia.
Eur Arch Otorhinolaryngol. 2024 Dec;281(12):6405-6413. doi: 10.1007/s00405-024-08894-5. Epub 2024 Aug 22.
Subperiosteal abscess (SPA) can lead to devastating morbidity and mortality. Prompt management is important; however, the choice of management route is controversial. This study investigates factors associated with surgical management and defines a cut-off abscess volume prompting surgical intervention.
SPA cases presented to King Saud University Medical City (KSUMC) from 2014 to 2023 were reviewed. The surgical approach was studied in association with factors including age, gender, symptoms and signs, laboratory results, computed tomography (CT) characteristics, medications, and surgical approach. Multiple statistical tests were used for analysis, including student t-test, chi-square, multiple logistic regression analysis, and receiver operating characteristic (ROC) analysis.
Patients were managed medically (n = 14, 45.16%) or surgically (n = 17, 54.84%). The average duration of antibiotics was 15 days. Superior SPA favors surgical management (OR = 6.722, CI [1.332-33.913], p = 0.029), along with the use of steroids (OR = 5.625, CI [0.915-34.572], p = 0.049), and abscess volume (OR = 10.003, CI [1.418-70.540], p < 0.001). However, the only factor attributing to a surgical decision on multivariate logistic regression analysis was abscess volume (OR = 5.126, CI [1.023-25.694], p = 0.047). SPA volume of ≥ 0.648 ml strongly prompts surgical management, with a sensitivity of 94.1% and a specificity of 71.4% (p = 0.000).
SPA volume increases the likelihood of surgical intervention by five times, especially when abscess volume is ≥ 0.648 ml.
骨膜下脓肿（SPA）可导致严重的发病率和死亡率。及时治疗非常重要；然而，治疗途径的选择存在争议。本研究调查了与手术治疗相关的因素，并确定了提示手术干预的脓肿体积临界值。
回顾了 2014 年至 2023 年在沙特国王大学医学城（KSUMC）就诊的 SPA 病例。研究了手术方法与包括年龄、性别、症状和体征、实验室结果、计算机断层扫描（CT）特征、药物和手术方法在内的因素之间的关系。使用了多种统计检验进行分析，包括学生 t 检验、卡方检验、多因素逻辑回归分析和接收者操作特征（ROC）分析。
患者接受了药物治疗（n=14，45.16%）或手术治疗（n=17，54.84%）。抗生素的平均使用时间为 15 天。上 SPA 更倾向于手术治疗（OR=6.722，CI [1.332-33.913]，p=0.029），同时使用皮质类固醇（OR=5.625，CI [0.915-34.572]，p=0.049）和脓肿体积（OR=10.003，CI [1.418-70.540]，p<0.001）。然而，多因素逻辑回归分析中唯一导致手术决策的因素是脓肿体积（OR=5.126，CI [1.023-25.694]，p=0.047）。SPA 体积≥0.648ml 强烈提示手术治疗，其敏感性为 94.1%，特异性为 71.4%（p=0.000）。
SPA 体积增加了手术干预的可能性，增加了五倍，尤其是当脓肿体积≥0.648ml 时。
