Orbital abscess surgery in a patient with odontogenic pansinusitis

• Published in: Acta ophthalmologica (Oxford, England) Vol. 100; no. S275
• Main Authors: Carsi, Marta Comes, Tepper, Sergio Maugard, García, Maria Amparo Lanuza, Duch Samper, Antonio M.
• Format: Journal Article
• Language: English
• Published: Malden Wiley Subscription Services, Inc 01.12.2022
• Subjects: Abscesses; Cellulitis; Computed tomography; Endoscopy; Hydrogen peroxide; Metronidazole; Muscles; Orbital cellulitis; Otolaryngology; Patients; Periosteum; Rectus muscle; Sinuses; Surgery; Surgical drains; Wound drainage
• ISSN: 1755-375X; 1755-3768
• DOI: 10.1111/j.1755-3768.2022.0267

Purpose: In orbital abscesses with sinus origin, the most frequent treatment is a endoscopic sinus surgery (ENSS), if there is a subperiosteal abscess that may compromise the vision, an external drainage should be performed, depending on the location of the abscess. We present an orbital abscess of odontogenic cause that required an orbital approach. Methods: We present an orbital abscess in a 44‐year‐old man with no relevant medical or ophthalmological history, who, after complicated dental extraction, suffered a left orbital cellulitis. Surgical technique: Ethmoidectomy was performed by endoscopic sinus surgery (ENSS), without resolution of the infection, requiring drainage of the abscess through an external orbital superomedial approach. Results: This abscess was located between the middle and superior rectus muscles. A superomedial incision was made, dissecting up to the periosteum and incising the periorbita, observing the exit of purulent material. A drainage was left in place. At the same time, ENSS was performed with exeresis of the lamina papyracea. The patient evolved torpidly, with productive drainage. Computed tomography (CT) shows two collections adjacent to the drainage and the thickening of the lateral rectus muscle. Reoperation was performed, draining the abscesses visualized and washing the area with hydrogen peroxide and metronidazole. New drainage was placed. The evolution was favourable. Conclusions: In orbital abscesses, antibiotic therapy is usually not sufficient, and surgical intervention is indicated. There are various types of procedures and surgical approaches for the drainage of orbital abscesses, the most common is ENSS, but in complex abscesses an external approach may be necessary. Imaging tests facilitate the location of the abscess, serving as a guide for surgery.