Orbital cellulitis and subperiosteal abscess: A 5-year outcomes analysis

Purpose: Orbital cellulitis and subperiosteal abscess (SPA) are historically associated with poor outcomes. We seek to characterize current associations with abscess formation, surgical failure and vision loss. Methods: All cases of orbital cellulitis presenting to an affiliated hospital between April 2008 and 2013 were critically reviewed. Results: Thirty patients met inclusion criteria. Average age was 28.7±24.4. The male to female ratio was 2:1. Abscesses were identified in 56.7% of patients. Adults were less likely than children to present with abscesses (28.6% vs. 81.3%, p=0.008). Of the other factors analyzed, only antibiotic use before admission (70.5% vs. 23.1%, p=0.03) and maximum restriction (-2.5±1.2 vs. -0.9±0.7, p=0.008) were associated with SPA. Temperature at presentation (37.9±0.9 vs. 37.1±0.4, p=0.04), relative proptosis (5.8±3.3mm vs. 2.1±1.1, p=0.002) and abscess volume (4.3±1.3mm³ vs. 0.7±0.5mm³, p=0.0004) were associated with progression to surgery. Reoperation was required in 26.7% of patients. Of these, two-thirds had combined superior/medial abscesses that re-accumulated after isolated endonasal surgery. Two of the 3 patients with profound vision loss had a dental etiology. Conclusions: Only young age, prior antibiotics and degree of restriction predicted the presence of an abscess. Re-accumulation was more common than anticipated, and drainage of superior/medial abscesses by endoscopic surgery alone had the strongest association with surgical failure. Patients with odontogenic abscesses must be treated with particular caution.