Cosmetic Considerations in Surgery for Orbital Subperiosteal Abscess in Children: Experience With a Combined Transcaruncular and Transnasal Endoscopic Approach.

Objective: To evaluate the outcomes of a new surgical approach in children with acute sinusitis and medial orbital subperiosteal abscess. Design: Case series. Setting: Tertiary pediatric hospital. Patients: Eleven children aged 6 weeks to 13 years with orbital subperiosteal abscess and acute sinusitis who met indication for surgery by visual compromise and/or refractory course to medical therapy. Intervention: The medial orbital abscess was drained via a transcaruncular approach, which provided access to the medial orbital wall. An endoscopic ethmoidec-tomy was also performed. Main Outcome Measures: Judgment of cosmetic appearance by surgeon and family, resolution of symptoms, length of hospital stay, and complications. Results: All children had prompt resolution of symptoms after surgical drainage. Cosmetic outcome was excellent in all patients with no cutaneous scar or eyelid mal-position. After edema and cellulitis had resolved, no family member could tell a difference in appearance between the eyes. No complications of these combined procedures were identified. One patient who had initially undergone trans-nasal endoscopic orbital drainage alone experienced a recurrence of infection 17 days later. He was then treated by the combined transcaruncular and endoscopic approach with prompt resolution of his symptoms. One of 4 patients treated initially with transcaruncular approach alone without endoscopic ethmoidectomy had recurrence of acute sinusitis and orbital abscess 16 months later and was successfully treated with an endoscopic approach. Conclusions: The combined endoscopic and transca-runcular surgical approach to medial orbital subperios-teal abscess and acute sinusitis provides a cosmetically superior outcome compared with standard orbital approaches requiring a cutaneous incision. The transca-runcular approach can be considered as an alternative or adjunct approach to the medial orbit, with the same cosmetic advantages as transnasal endoscopic drainage. [ABSTRACT FROM AUTHOR]