Combined drainage of subperiosteal orbital abscess complicating ethmoiditis

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Author: François. Simon
Published:
Specialties: Endoscopy, Otolaryngology, Pediatric Otolaryngology, Pediatric Surgery, Rhinology Skullbased
Schools: Necker Hospital, Paris Descartes University
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A 4 year-old boy presented to our tertiary center with acute left ethmoiditis and a subperiosteal orbital abscess. He presented with exophtalmia but had no visual impairment or limitation of ocular mobility.

CT-scan found a 8 mm large subperiosteal orbital abscess with no further complications.

Surgery was decided using a combined approach to drain the abscess and to obtain a bacterial sample: first external (incision in the inner canthus area) and then endonasal (functional endoscopic sinus surgery - FESS) to open the middle meatus and ethmoid.

External approach: 10 mm incision in the inner canthus region, elevation of the lamina papyracea periosteum until the abscess was reached. Rubber drain was put in place for irrigation.

Endonasal approach: after careful CT-scan examination, endonasal surgery was performed with a 30° rigid endoscope. The middle turbinate was medialised to expose the middle meatus, uncinectomy and antrostomy followed by anterior and posterior ethmoidectomy was performed.

Antibiotics were given intravenously for 5 days and saline irrigation on the drain was performed during 2 days. Patient was discharged after 5 days.

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