- Email: [email protected]
Image-guided nasal endoscopic drainage of an orbital superior subperiosteal abscess
YBJOM-4717; No. of Pages 3
ARTICLE IN PRESS Available online at www.sciencedirect.com
British Journal of Oral and Maxillofacial Surgery xxx (2015) xxx.e1–xxx.e3
Short communication
Image-guided nasal endoscopic drainage of an orbital superior subperiosteal abscess Jeong Hong Kim, Se-Hyung Kim, Chan Il Song, Ju Wan Kang ∗ Department of Otorhinolaryngology-Head and Neck Surgery, Jeju National University School of Medicine, Jeju, Korea Accepted 6 December 2015
Abstract A 48-year-old woman presented to the emergency department with swelling and erythema of the right upper eyelid for 4 days. Computed tomography showed a superiorly-based subperiosteal orbital abscess together with paranasal sinusitis. She was managed medically, but symptoms did not improve, so we drained the abscess using image-guided intranasal endoscopy. Her symptoms began to improve 2 days after drainage, and her recovery was uneventful. Drainage of an orbital subperiosteal abscess should be considered if there are ophthalmological symptoms such as visual disturbances, raised intraocular pressure, or proptosis of over 5 mm. Various approaches are available, but endoscopic intranasal drainage was thought to be the most safe and effective. Image-guided drainage may help to minimise the extent and risk of operative complications. © 2015 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
Keywords: Subperiosteal abscess; Intranasal; Navigation; Image-guided
Introduction Orbital subperiosteal abscesses are usually the result of chronic sinusitis, 1 and may progress to severe complications such as visual loss, thrombosis of the cavernous sinus, and cerebral abscess.1,2 Efforts should therefore be made to diagnose them early and manage them properly. Generally, antibiotics are given to patients without severe morbidity. However, operation is necessary for patients who do not respond to medical treatment within 48 hours or whose symptoms worsen rapidly.3 The endoscopic drainage of these abscesses was reported in 1993 by Manning (quoted by4 ), but endoscopic drainage of superiorly or inferiorly located abscesses is still controversial.5 We report an orbital
∗ Corresponding author at: Department of Otorhinolaryngology, Jeju National University School of Medicine, 102 Jejudaehakno, Jeju 690-756, South Korea. Tel.: +82 64 717 1720; fax: +82 64 717 1029. E-mail address: [email protected] (J.W. Kang).
subperiosteal abscess managed by image-guided, nasal endoscopic drainage. Case Report A 48-year-old woman presented to the emergency department with a 2-week history of right-sided headache and orbital pain, with swelling of the right upper eyelid and erythema that had worsened during the previous 4 days. She had no visual disturbance or oculomotor weakness, and no history of sinonasal disease or facial trauma. An ophthalmological examination showed good visual acuity, although her intraocular pressure was raised and she had some proptosis. Computed tomography (CT) showed a superiorlybased subperiosteal orbital abscess and paranasal sinusitis (Fig. 1). She was initially managed with antibiotics and mannitol given intravenously but her symptoms did not improve, so the abscess was drained using an intranasal endoscopic
http://dx.doi.org/10.1016/j.bjoms.2015.12.003 0266-4356/© 2015 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
Please cite this article in press as: Kim JH, et al. Image-guided nasal endoscopic drainage of an orbital superior subperiosteal abscess. Br J Oral Maxillofac Surg (2015), http://dx.doi.org/10.1016/j.bjoms.2015.12.003
YBJOM-4717; No. of Pages 3
xxx.e2
ARTICLE IN PRESS J.H. Kim et al. / British Journal of Oral and Maxillofacial Surgery xxx (2015) xxx.e1–xxx.e3
image-guided surgical system (Figs. 2 and 3). Symptoms of orbital pain, swelling of the eyelid, and redness started to improve from postoperative day 2. She was discharged after 7 days of antibiotics intravenously.
Discussion
Fig. 1. Preoperative computed tomographic scans of the paranasal sinus showing a superomedial subperiosteal abscess in the right orbit and inflammation in the right maxillary and ethmoid sinuses.
While orbital subperiosteal abscesses are rare, they can be life-threatening, and have the potential to progress to permanent blindness.2 They can be diagnosed from clinical symptoms such as swelling of the eyelids and conjunctiva, proptosis, limitations of movement of the extraocular muscles, visual disturbances, and from radiological investigations.4 CT is usually used for the diagnosis and planning of treatment.3,6 Generally, medical treatment including antibiotics given intravenously may be used as the first line of treatment in patients with less severe symptoms.3 However, intervention should be considered in patients with severe ophthalmic symptoms such as visual disturbances, raised intraocular
Fig. 2. The abscess pocket accurately indicated through the image-guided endoscopic view with the ostium seeker tracker (green dot).
Please cite this article in press as: Kim JH, et al. Image-guided nasal endoscopic drainage of an orbital superior subperiosteal abscess. Br J Oral Maxillofac Surg (2015), http://dx.doi.org/10.1016/j.bjoms.2015.12.003
YBJOM-4717; No. of Pages 3
ARTICLE IN PRESS J.H. Kim et al. / British Journal of Oral and Maxillofacial Surgery xxx (2015) xxx.e1–xxx.e3
xxx.e3
In conclusion, we think that image-guided endoscopic drainage might be helpful to minimise the extent of intervention and the risk of operation-related complications.
Conflict of Interest We have no conflict of interest.
Ethics statement/confirmation of patient pemrission This work was approved by Institutional Review Board of the National University Hospital.
Funding Fig. 3. Drainage of the subperiosteal orbital abscess.
pressure, or proptosis of over 5 mm.3 Any abscess over 10 mm in size on CT might be an indication for drainage.3 Gavriel et al. suggested that drainage should be strongly considered for abscesses more than 17 mm long and 4.5 mm wide.6 There is no consensus about the best approach to such abscesses, particularly those located superiorly, though endoscopic intranasal approaches have been supported by recent reports of their safety and efficacy.5,7 Lyson et al reported that intraoperative sonography is useful for their endoscopic management if they are located superiorly.5 In cases of orbital conditions such as mucocele, intraorbital abscess, and fungal mycetoma,which required the decompression of at least one wall of the orbit, some studies have reported good results with no appreciable complications after a transnasal image-guided endoscopic procedure.8,9 We recently drained a superiorly-located subperiosteal orbital abscess endoscopically using an image-guided surgical system that allowed safe and efficient identification of the pocket of the abscess. We were also able to preserve the lamina papyracea without having to resect it widely. When draining these abscesses endoscopically there is no consensus about how much of the lamina papyracea should be resected, and Khalifa reported that a minimal resection may be sufficient to drain the abscess, without additional intervention.10
None
References 1. Tanna N, Preciado DA, Clary MS, et al. Surgical treatment of subperiosteal orbital abscess. Arch Otolaryngol Head Neck Surg 2008;134:764–7. 2. Le TD, Liu ES, Adatia FA, et al. The effect of adding orbital computed tomography findings to the Chandler criteria for classifying pediatric orbital cellulitis in predicting which patients will require surgical intervention. JAAPOS 2014;18:271–7. 3. Bedwell JR, Choi SS. Medical versus surgical management of pediatric orbital subperiosteal abscesses. Laryngoscope 2013;123:2337–8. 4. Kayhan FT, Sayin I, Yazici ZM, et al. Management of orbital subperiosteal abscess. J Craniofac Surg 2010;21:1114–7. 5. Lyson T, Sieskiewicz A, Rutkowski R, et al. Endoscopic drainage of orbital abscesses aided with intraoperative sonography. Neurol Neurochir Pol 2014;48:315–21. 6. Gavriel H, Yeheskeli E, Aviram E, et al. Dimension of subperiosteal orbital abscess as an indication for surgical management in children. Otolaryngol Head Neck Surg 2011;145:823–7. 7. Roithmann R, Uren B, Pater J, et al. Endoscopic drainage of a superiorly based subperiosteal orbital abscess. Laryngoscope 2008;118:162–4. 8. Camara JG, Nguyen LT, Fernandez-Suntay JP, et al. The use of a computer-assisted image-guided system (InstaTrak) in orbital surgery. Ophthal Plast Reconstr Surg 2001;17:447–51. 9. Kent JS, Allen LH, Rotenberg BW. Image-guided transnasal endoscopic techniques in the management of orbital disease. Orbit 2010;29: 328–33. 10. Khalifa BC. Extent of resection of the lamina papyracea in medial subperiosteal abscess. Otolaryngol Head Neck Surg 2011;145:161–4.
Please cite this article in press as: Kim JH, et al. Image-guided nasal endoscopic drainage of an orbital superior subperiosteal abscess. Br J Oral Maxillofac Surg (2015), http://dx.doi.org/10.1016/j.bjoms.2015.12.003
ARTICLE IN PRESS Available online at www.sciencedirect.com
British Journal of Oral and Maxillofacial Surgery xxx (2015) xxx.e1–xxx.e3
Short communication
Image-guided nasal endoscopic drainage of an orbital superior subperiosteal abscess Jeong Hong Kim, Se-Hyung Kim, Chan Il Song, Ju Wan Kang ∗ Department of Otorhinolaryngology-Head and Neck Surgery, Jeju National University School of Medicine, Jeju, Korea Accepted 6 December 2015
Abstract A 48-year-old woman presented to the emergency department with swelling and erythema of the right upper eyelid for 4 days. Computed tomography showed a superiorly-based subperiosteal orbital abscess together with paranasal sinusitis. She was managed medically, but symptoms did not improve, so we drained the abscess using image-guided intranasal endoscopy. Her symptoms began to improve 2 days after drainage, and her recovery was uneventful. Drainage of an orbital subperiosteal abscess should be considered if there are ophthalmological symptoms such as visual disturbances, raised intraocular pressure, or proptosis of over 5 mm. Various approaches are available, but endoscopic intranasal drainage was thought to be the most safe and effective. Image-guided drainage may help to minimise the extent and risk of operative complications. © 2015 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
Keywords: Subperiosteal abscess; Intranasal; Navigation; Image-guided
Introduction Orbital subperiosteal abscesses are usually the result of chronic sinusitis, 1 and may progress to severe complications such as visual loss, thrombosis of the cavernous sinus, and cerebral abscess.1,2 Efforts should therefore be made to diagnose them early and manage them properly. Generally, antibiotics are given to patients without severe morbidity. However, operation is necessary for patients who do not respond to medical treatment within 48 hours or whose symptoms worsen rapidly.3 The endoscopic drainage of these abscesses was reported in 1993 by Manning (quoted by4 ), but endoscopic drainage of superiorly or inferiorly located abscesses is still controversial.5 We report an orbital
∗ Corresponding author at: Department of Otorhinolaryngology, Jeju National University School of Medicine, 102 Jejudaehakno, Jeju 690-756, South Korea. Tel.: +82 64 717 1720; fax: +82 64 717 1029. E-mail address: [email protected] (J.W. Kang).
subperiosteal abscess managed by image-guided, nasal endoscopic drainage. Case Report A 48-year-old woman presented to the emergency department with a 2-week history of right-sided headache and orbital pain, with swelling of the right upper eyelid and erythema that had worsened during the previous 4 days. She had no visual disturbance or oculomotor weakness, and no history of sinonasal disease or facial trauma. An ophthalmological examination showed good visual acuity, although her intraocular pressure was raised and she had some proptosis. Computed tomography (CT) showed a superiorlybased subperiosteal orbital abscess and paranasal sinusitis (Fig. 1). She was initially managed with antibiotics and mannitol given intravenously but her symptoms did not improve, so the abscess was drained using an intranasal endoscopic
http://dx.doi.org/10.1016/j.bjoms.2015.12.003 0266-4356/© 2015 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
Please cite this article in press as: Kim JH, et al. Image-guided nasal endoscopic drainage of an orbital superior subperiosteal abscess. Br J Oral Maxillofac Surg (2015), http://dx.doi.org/10.1016/j.bjoms.2015.12.003
YBJOM-4717; No. of Pages 3
xxx.e2
ARTICLE IN PRESS J.H. Kim et al. / British Journal of Oral and Maxillofacial Surgery xxx (2015) xxx.e1–xxx.e3
image-guided surgical system (Figs. 2 and 3). Symptoms of orbital pain, swelling of the eyelid, and redness started to improve from postoperative day 2. She was discharged after 7 days of antibiotics intravenously.
Discussion
Fig. 1. Preoperative computed tomographic scans of the paranasal sinus showing a superomedial subperiosteal abscess in the right orbit and inflammation in the right maxillary and ethmoid sinuses.
While orbital subperiosteal abscesses are rare, they can be life-threatening, and have the potential to progress to permanent blindness.2 They can be diagnosed from clinical symptoms such as swelling of the eyelids and conjunctiva, proptosis, limitations of movement of the extraocular muscles, visual disturbances, and from radiological investigations.4 CT is usually used for the diagnosis and planning of treatment.3,6 Generally, medical treatment including antibiotics given intravenously may be used as the first line of treatment in patients with less severe symptoms.3 However, intervention should be considered in patients with severe ophthalmic symptoms such as visual disturbances, raised intraocular
Fig. 2. The abscess pocket accurately indicated through the image-guided endoscopic view with the ostium seeker tracker (green dot).
Please cite this article in press as: Kim JH, et al. Image-guided nasal endoscopic drainage of an orbital superior subperiosteal abscess. Br J Oral Maxillofac Surg (2015), http://dx.doi.org/10.1016/j.bjoms.2015.12.003
YBJOM-4717; No. of Pages 3
ARTICLE IN PRESS J.H. Kim et al. / British Journal of Oral and Maxillofacial Surgery xxx (2015) xxx.e1–xxx.e3
xxx.e3
In conclusion, we think that image-guided endoscopic drainage might be helpful to minimise the extent of intervention and the risk of operation-related complications.
Conflict of Interest We have no conflict of interest.
Ethics statement/confirmation of patient pemrission This work was approved by Institutional Review Board of the National University Hospital.
Funding Fig. 3. Drainage of the subperiosteal orbital abscess.
pressure, or proptosis of over 5 mm.3 Any abscess over 10 mm in size on CT might be an indication for drainage.3 Gavriel et al. suggested that drainage should be strongly considered for abscesses more than 17 mm long and 4.5 mm wide.6 There is no consensus about the best approach to such abscesses, particularly those located superiorly, though endoscopic intranasal approaches have been supported by recent reports of their safety and efficacy.5,7 Lyson et al reported that intraoperative sonography is useful for their endoscopic management if they are located superiorly.5 In cases of orbital conditions such as mucocele, intraorbital abscess, and fungal mycetoma,which required the decompression of at least one wall of the orbit, some studies have reported good results with no appreciable complications after a transnasal image-guided endoscopic procedure.8,9 We recently drained a superiorly-located subperiosteal orbital abscess endoscopically using an image-guided surgical system that allowed safe and efficient identification of the pocket of the abscess. We were also able to preserve the lamina papyracea without having to resect it widely. When draining these abscesses endoscopically there is no consensus about how much of the lamina papyracea should be resected, and Khalifa reported that a minimal resection may be sufficient to drain the abscess, without additional intervention.10
None
References 1. Tanna N, Preciado DA, Clary MS, et al. Surgical treatment of subperiosteal orbital abscess. Arch Otolaryngol Head Neck Surg 2008;134:764–7. 2. Le TD, Liu ES, Adatia FA, et al. The effect of adding orbital computed tomography findings to the Chandler criteria for classifying pediatric orbital cellulitis in predicting which patients will require surgical intervention. JAAPOS 2014;18:271–7. 3. Bedwell JR, Choi SS. Medical versus surgical management of pediatric orbital subperiosteal abscesses. Laryngoscope 2013;123:2337–8. 4. Kayhan FT, Sayin I, Yazici ZM, et al. Management of orbital subperiosteal abscess. J Craniofac Surg 2010;21:1114–7. 5. Lyson T, Sieskiewicz A, Rutkowski R, et al. Endoscopic drainage of orbital abscesses aided with intraoperative sonography. Neurol Neurochir Pol 2014;48:315–21. 6. Gavriel H, Yeheskeli E, Aviram E, et al. Dimension of subperiosteal orbital abscess as an indication for surgical management in children. Otolaryngol Head Neck Surg 2011;145:823–7. 7. Roithmann R, Uren B, Pater J, et al. Endoscopic drainage of a superiorly based subperiosteal orbital abscess. Laryngoscope 2008;118:162–4. 8. Camara JG, Nguyen LT, Fernandez-Suntay JP, et al. The use of a computer-assisted image-guided system (InstaTrak) in orbital surgery. Ophthal Plast Reconstr Surg 2001;17:447–51. 9. Kent JS, Allen LH, Rotenberg BW. Image-guided transnasal endoscopic techniques in the management of orbital disease. Orbit 2010;29: 328–33. 10. Khalifa BC. Extent of resection of the lamina papyracea in medial subperiosteal abscess. Otolaryngol Head Neck Surg 2011;145:161–4.
Please cite this article in press as: Kim JH, et al. Image-guided nasal endoscopic drainage of an orbital superior subperiosteal abscess. Br J Oral Maxillofac Surg (2015), http://dx.doi.org/10.1016/j.bjoms.2015.12.003