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Management of subperiosteal orbital abscess in pediatric population: a comparative study.

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Title: Management of subperiosteal orbital abscess in pediatric population: a comparative study.
Authors: Abumanhal M; Oculoplastic, Orbital and Lacrimal Institute, Division of Ophthalmology, Tel Aviv University, Tel Aviv, Israel; Tel Aviv Medical Center, Tel Aviv, Israel, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.. Electronic address: mabumanhal@hotmail.com., Leibovitch I; Oculoplastic, Orbital and Lacrimal Institute, Division of Ophthalmology, Tel Aviv University, Tel Aviv, Israel; Tel Aviv Medical Center, Tel Aviv, Israel, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel., Niry D; Neuroradiology, Division of Radiology Tel Aviv University, Tel Aviv, Israel; Tel Aviv Medical Center, Tel Aviv, Israel, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel., Ahmad NS; Oculoplastic, Orbital and Lacrimal Institute, Division of Ophthalmology, Tel Aviv University, Tel Aviv, Israel; Tel Aviv Medical Center, Tel Aviv, Israel, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel., Mezad-Koursh D; Pediatric Unit, Division of Ophthalmology, Tel Aviv University, Tel Aviv, Israel; Tel Aviv Medical Center, Tel Aviv, Israel, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel., Zipori AB; Pediatric Unit, Division of Ophthalmology, Tel Aviv University, Tel Aviv, Israel; Tel Aviv Medical Center, Tel Aviv, Israel, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel., Abergel A; Ear, Nose and Throat Department, Tel Aviv University, Tel Aviv, Israel; Tel Aviv Medical Center, Tel Aviv, Israel, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel., Cnaan RB; Oculoplastic, Orbital and Lacrimal Institute, Division of Ophthalmology, Tel Aviv University, Tel Aviv, Israel; Tel Aviv Medical Center, Tel Aviv, Israel, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Source: Canadian journal of ophthalmology. Journal canadien d'ophtalmologie [Can J Ophthalmol] 2026 Oct; Vol. 61 (5), pp. 1200-1208. Date of Electronic Publication: 2025 Jul 14.
Publication Type: Journal Article; Comparative Study
Language: English
Journal Info: Publisher: Elsevier Country of Publication: England NLM ID: 0045312 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1715-3360 (Electronic) Linking ISSN: 00084182 NLM ISO Abbreviation: Can J Ophthalmol Subsets: MEDLINE
Imprint Name(s): Publication: June 2011- : Oxford, England : Elsevier
Original Publication: Montreal, Canadian Ophthalmological Society.
MeSH Terms: Abscess*/therapy , Abscess*/diagnosis , Abscess*/microbiology , Orbital Cellulitis*/diagnosis , Orbital Cellulitis*/therapy , Eye Infections, Bacterial*/diagnosis , Eye Infections, Bacterial*/microbiology , Eye Infections, Bacterial*/therapy , Ophthalmologic Surgical Procedures*/methods , Disease Management*, Tomography, X-Ray Computed/methods ; Anti-Bacterial Agents/therapeutic use ; Drainage/methods ; Humans ; Retrospective Studies ; Female ; Male ; Child, Preschool ; Child ; Periosteum ; Infant ; Imaging, Three-Dimensional
Abstract: Objective: To assess clinical and radiological parameters as predictive factors for surgical intervention in children diagnosed with subperiosteal orbital abscess (SPOA).
Methods: A retrospective study conducted over 8 years (2016-2023) at a tertiary medical center. A total of 624 children with periorbital/orbital cellulitis were assessed for eligibility. Orbital imaging was performed on 107 children, and 45 were diagnosed with SPOA and included for this study. Patients diagnosed with SPOA were divided into two groups: conservative treatment (n = 20) and surgical intervention (n = 25). Clinical and laboratory parameters were evaluated. Radiological parameters, including abscess volume, abscess dimensions, and proptosis, were measured using three-dimensional imaging techniques.
Results: Age, fever, leukocyte count, and C-reactive protein levels did not significantly differ between the surgical and conservative groups. However, neutrophils to lymphocytes ratio (NLR) was significantly higher in the surgical group (8.1 vs 3.64; p < 0.001). Radiological findings showed that both absolute radiological proptosis (19 mm vs 16.1 mm; p < 0.001), and the difference in proptosis between the affected and fellow eyes (4 mm vs 2.1 mm; p < 0.001) were significantly greater in the surgical group. A relative abscess volume ≥0.11 mL was found to predict the need for surgery with a sensitivity of 88% and specificity of 85%. Anteroposterior and craniocaudal dimensions of the abscess were significantly larger in the surgical group.
Conclusion: NLR and radiological parameters, particularly proptosis and abscess volume, are valuable predictors of surgical intervention in children with SPOA. These findings suggest that combining clinical and radiological assessments can improve decision making for treating pediatric orbital infections, potentially guiding timely surgical management.
(Copyright © 2025 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.)
Substance Nomenclature: 0 (Anti-Bacterial Agents)
Entry Date(s): Date Created: 20250629 Date Completed: 20260905 Latest Revision: 20260905
Update Code: 20260906
DOI: 10.1016/j.jcjo.2025.06.004
PMID: 40582701
Database: MEDLINE
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  Data: Management of subperiosteal orbital abscess in pediatric population: a comparative study.
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  Data: &lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Abumanhal+M%22&quot;&gt;Abumanhal M&lt;/searchLink&gt;; Oculoplastic, Orbital and Lacrimal Institute, Division of Ophthalmology, Tel Aviv University, Tel Aviv, Israel; Tel Aviv Medical Center, Tel Aviv, Israel, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.. Electronic address: mabumanhal@hotmail.com.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Leibovitch+I%22&quot;&gt;Leibovitch I&lt;/searchLink&gt;; Oculoplastic, Orbital and Lacrimal Institute, Division of Ophthalmology, Tel Aviv University, Tel Aviv, Israel; Tel Aviv Medical Center, Tel Aviv, Israel, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Niry+D%22&quot;&gt;Niry D&lt;/searchLink&gt;; Neuroradiology, Division of Radiology Tel Aviv University, Tel Aviv, Israel; Tel Aviv Medical Center, Tel Aviv, Israel, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Ahmad+NS%22&quot;&gt;Ahmad NS&lt;/searchLink&gt;; Oculoplastic, Orbital and Lacrimal Institute, Division of Ophthalmology, Tel Aviv University, Tel Aviv, Israel; Tel Aviv Medical Center, Tel Aviv, Israel, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Mezad-Koursh+D%22&quot;&gt;Mezad-Koursh D&lt;/searchLink&gt;; Pediatric Unit, Division of Ophthalmology, Tel Aviv University, Tel Aviv, Israel; Tel Aviv Medical Center, Tel Aviv, Israel, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Zipori+AB%22&quot;&gt;Zipori AB&lt;/searchLink&gt;; Pediatric Unit, Division of Ophthalmology, Tel Aviv University, Tel Aviv, Israel; Tel Aviv Medical Center, Tel Aviv, Israel, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Abergel+A%22&quot;&gt;Abergel A&lt;/searchLink&gt;; Ear, Nose and Throat Department, Tel Aviv University, Tel Aviv, Israel; Tel Aviv Medical Center, Tel Aviv, Israel, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Cnaan+RB%22&quot;&gt;Cnaan RB&lt;/searchLink&gt;; Oculoplastic, Orbital and Lacrimal Institute, Division of Ophthalmology, Tel Aviv University, Tel Aviv, Israel; Tel Aviv Medical Center, Tel Aviv, Israel, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
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  Data: &lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Abscess%22&quot;&gt;Abscess*&lt;/searchLink&gt;/&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Abscess+therapy%22&quot;&gt;therapy&lt;/searchLink&gt; &lt;br /&gt;&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Abscess%22&quot;&gt;Abscess*&lt;/searchLink&gt;/&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Abscess+diagnosis%22&quot;&gt;diagnosis&lt;/searchLink&gt; &lt;br /&gt;&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Abscess%22&quot;&gt;Abscess*&lt;/searchLink&gt;/&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Abscess+microbiology%22&quot;&gt;microbiology&lt;/searchLink&gt; &lt;br /&gt;&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Orbital+Cellulitis%22&quot;&gt;Orbital Cellulitis*&lt;/searchLink&gt;/&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Orbital+Cellulitis+diagnosis%22&quot;&gt;diagnosis&lt;/searchLink&gt; &lt;br /&gt;&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Orbital+Cellulitis%22&quot;&gt;Orbital Cellulitis*&lt;/searchLink&gt;/&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Orbital+Cellulitis+therapy%22&quot;&gt;therapy&lt;/searchLink&gt; &lt;br /&gt;&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Eye+Infections%2C+Bacterial%22&quot;&gt;Eye Infections, Bacterial*&lt;/searchLink&gt;/&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Eye+Infections%2C+Bacterial+diagnosis%22&quot;&gt;diagnosis&lt;/searchLink&gt; &lt;br /&gt;&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Eye+Infections%2C+Bacterial%22&quot;&gt;Eye Infections, Bacterial*&lt;/searchLink&gt;/&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Eye+Infections%2C+Bacterial+microbiology%22&quot;&gt;microbiology&lt;/searchLink&gt; &lt;br /&gt;&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Eye+Infections%2C+Bacterial%22&quot;&gt;Eye Infections, Bacterial*&lt;/searchLink&gt;/&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Eye+Infections%2C+Bacterial+therapy%22&quot;&gt;therapy&lt;/searchLink&gt; &lt;br /&gt;&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Ophthalmologic+Surgical+Procedures%22&quot;&gt;Ophthalmologic Surgical Procedures*&lt;/searchLink&gt;/&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Ophthalmologic+Surgical+Procedures+methods%22&quot;&gt;methods&lt;/searchLink&gt; &lt;br /&gt;&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Disease+Management%22&quot;&gt;Disease Management*&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Tomography%2C+X-Ray+Computed%22&quot;&gt;Tomography, X-Ray Computed&lt;/searchLink&gt;/&lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Tomography%2C+X-Ray+Computed+methods%22&quot;&gt;methods&lt;/searchLink&gt; ; &lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Anti-Bacterial+Agents%22&quot;&gt;Anti-Bacterial Agents&lt;/searchLink&gt;/&lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Anti-Bacterial+Agents+therapeutic+use%22&quot;&gt;therapeutic use&lt;/searchLink&gt; ; &lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Drainage%22&quot;&gt;Drainage&lt;/searchLink&gt;/&lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Drainage+methods%22&quot;&gt;methods&lt;/searchLink&gt; ; &lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Humans%22&quot;&gt;Humans&lt;/searchLink&gt; ; &lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Retrospective+Studies%22&quot;&gt;Retrospective Studies&lt;/searchLink&gt; ; &lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Female%22&quot;&gt;Female&lt;/searchLink&gt; ; &lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Male%22&quot;&gt;Male&lt;/searchLink&gt; ; &lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Child%2C+Preschool%22&quot;&gt;Child, Preschool&lt;/searchLink&gt; ; &lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Child%22&quot;&gt;Child&lt;/searchLink&gt; ; &lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Periosteum%22&quot;&gt;Periosteum&lt;/searchLink&gt; ; &lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Infant%22&quot;&gt;Infant&lt;/searchLink&gt; ; &lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Imaging%2C+Three-Dimensional%22&quot;&gt;Imaging, Three-Dimensional&lt;/searchLink&gt;
– Name: Abstract
  Label: Abstract
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  Data: Objective: To assess clinical and radiological parameters as predictive factors for surgical intervention in children diagnosed with subperiosteal orbital abscess (SPOA).&lt;br /&gt;Methods: A retrospective study conducted over 8 years (2016-2023) at a tertiary medical center. A total of 624 children with periorbital/orbital cellulitis were assessed for eligibility. Orbital imaging was performed on 107 children, and 45 were diagnosed with SPOA and included for this study. Patients diagnosed with SPOA were divided into two groups: conservative treatment (n = 20) and surgical intervention (n = 25). Clinical and laboratory parameters were evaluated. Radiological parameters, including abscess volume, abscess dimensions, and proptosis, were measured using three-dimensional imaging techniques.&lt;br /&gt;Results: Age, fever, leukocyte count, and C-reactive protein levels did not significantly differ between the surgical and conservative groups. However, neutrophils to lymphocytes ratio (NLR) was significantly higher in the surgical group (8.1 vs 3.64; p &amp;lt; 0.001). Radiological findings showed that both absolute radiological proptosis (19 mm vs 16.1 mm; p &amp;lt; 0.001), and the difference in proptosis between the affected and fellow eyes (4 mm vs 2.1 mm; p &amp;lt; 0.001) were significantly greater in the surgical group. A relative abscess volume ≥0.11 mL was found to predict the need for surgery with a sensitivity of 88% and specificity of 85%. Anteroposterior and craniocaudal dimensions of the abscess were significantly larger in the surgical group.&lt;br /&gt;Conclusion: NLR and radiological parameters, particularly proptosis and abscess volume, are valuable predictors of surgical intervention in children with SPOA. These findings suggest that combining clinical and radiological assessments can improve decision making for treating pediatric orbital infections, potentially guiding timely surgical management.&lt;br /&gt; (Copyright &#169; 2025 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.)
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        Type: general
      – SubjectFull: Anti-Bacterial Agents therapeutic use
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