Surgical Management of Subperiosteal Orbital Abscess Secondary to Pediatric Acute Sinusitis: A Case Series Study

Background: Subperiosteal Orbital Abscess (SPOA) is a frequent complication of acute rhinosinusitis especially in pediatric population This prospective case series study aimed to compare the outcomes of transnasal endoscopic (TNE) drainage versus external surgical approaches in the management of SPOA secondary to acute sinusitis. The study included 18 patients diagnosed with SPOA. Eleven patients were managed by an endoscopic approach, while 7 patients were managed by an open approach according to the surgical indication of each case. Data collected included demographic details, clinical findings, laboratory and radiological results, operative findings, and postoperative outcomes. Results: The median abscess volume was 1.9 cm3. Proptosis and ophthalmoplegia were the commonest clinical findings. Computed tomography imaging showed that the most involved sinuses were the ethmoid and maxillary (83.3%). Microbial culture was positive in 77.8% of cases, with S. pneumoniae being the most common pathogen. Recurrence occurred in 4 patients, all in the external group Duration of oral antibiotics and follow-up was significantly longer in the external group. No significant differences were found in hospital stay, IV antibiotic duration, or discharge antibiotics. Conclusion: Transnasal endoscopic drainage offers a safe, effective in the management of medially located subperiosteal orbital abscess, with the external approach reserved for superolateral abscesses. TNE is associated with lower recurrence rates, shorter durations of oral antibiotic use, and reduced postoperative follow-up needs. Both approaches, however, remain valid, and the choice should be tailored to the clinical scenario and site of the abscess.