Prospective Application of a Protocol for Selective Nonsurgical Management of Suspected Orbital Subperiosteal Abscesses in Children

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Goodwin et al (1982) and Souliere et al (1990) have proposed a protocol for the selective nonsurgical management of suspected orbital subperiosteal abscesses. This protocol has been routinely applied by the Temple Pediatric Otolaryngology and Ophthalmology services since 1990. During this period, children with computed tomography and physical examination findings consistent with orbital subperiosteal abscesses and visual acuity better than 20/60 were treated with intravenous antibiotics rather than immediate surgery. They were followed with frequent ophthalmologic examinations and operated upon if vision deteriorated or they failed to improve clinically within 48 hours. A review of patients admitted to St Christopher's Hospital for Children, the site of Temple University's pediatric activities in the years from 1991 to 1997, revealed 14 patients with clinical evidence of orbital subperiosteal abscesses. Twelve patients were treated in accordance with the Goodwin-Souliere protocol. All recovered completely without surgical intervention and without any adverse sequelae. Selective nonsurgical treatment of clinically diagnosed orbital subperiosteal abscesses in children is relatively safe and effective.

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