Abstract

Objective: In our study, we aimed to find out which factors the treatment method depends on in orbital complications and to shape the treatment scheme according to these factors.

Material and Methods: Patients who were treated and followed up for orbital complications of rhinosinusitis in the Karadeniz Technical University Faculty of Medicine, Department of Otorhinolaryngology, between 2007 and 2018 were retrospectively analyzed. A total of 64 patients were included in the study. Abscess volume and proptosis values of the patients with subperiosteal and orbital abscesses were calculated. The operative approach was recorded in patients treated surgically.

Results: It was determined that 48.4% of the patients were children and 51.6% were adults. The mean age was calculated as 26.3±20.5 years. Of these, 25% of the patients were female and 75% were male. Abscess was detected in 10 patients (15.6%). Subperiosteal abscesses were detected in 3 patients and orbital abscesses in 7 patients. The patients were classified as those with preseptal and orbital cellulitis (Group I), and those with subperiosteal abscess (SPA) and orbital abscess (Group II). Proptosis, restricted eye movements and fever were found to be significantly higher in Group II (p <0.05). The mean abscess volume of the patients in Group II was found to be 3210±1614 mm³, and the mean value of proptosis was found to be 4.24±1.7 mm. Surgery was performed on 24 patients. The mean abscess volumes in the surgical group and the non-surgical group were found to be 3800 mm³ and 850 mm³, respectively (p=0.034). The mean proptosis values in the surgical group and the non-surgical group were 4.91 mm and 1.55 mm, respectively (p=0,036).

Conclusion: Whether patients presenting with orbital complications should be treated conservatively or surgically remains a topic of debate in the current literature. In this discussion, it is important to predict which patients will progress to a subperiosteal or an orbital abscess. In our study, we found that proptosis, limited eye movements, and high fever (>37.5 °C) were associated with abscess development, and abscess volume and proptosis value were also important in terms of surgical necessity.

Keywords: orbital complication, sinusitis

Copyright and license

Copyright © 2026 The Author(s). This is an open-access article published by Bolu İzzet Baysal Training and Research Hospital under the terms of the Creative Commons Attribution License (CC BY) which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is properly cited.

How to cite

1.
Turgut Semerci H, Bahadır O, Çobanoğlu HB. When should we perform surgery in orbital complication due to rhinosinusitis?. Northwestern Med J. 2026;6(2):131-43. https://doi.org/10.54307/2026.NWMJ.164

References

  1. Lanza DC, Kennedy DW. Adult rhinosinusitis defined. Otolaryngol Head Neck Surg. 1997; 117(3): 1-7. https://doi.org/10.1016/S0194-59989770001-9
  2. Chandler JR, Langenbrunner DJ, Stevens ER. The pathogenesis of orbital complications in acute sinusitis. Laryngoscope. 1970; 80(9): 1414-28. https://doi.org/10.1288/00005537-197009000-00007
  3. Younis RT, Lazar RH, Bustillo A, Anand VK. Orbital infection as a complication of sinusitis: Are diagnostic and treatment trends changing? Ear Nose Throat J. 2002; 81(11): 771-5.
  4. Sobol SE, Marchand J, Tewfik TL, Manoukian JJ, Schloss MD. Orbital complications of sinusitis in children. J Otolaryngol. 2002; 31(3): 131-6. https://doi.org/10.2310/7070.2002.10979
  5. Manning SC. Endoscopic management of medial subperiosteal orbital abscess. Arch Otolaryngol Head Neck Surg. 1993; 119(7): 789-91. https://doi.org/10.1001/archotol.1993.01880190085018
  6. Erickson BP, Lee WW. Orbital cellulitis and subperiosteal abscess: A 5-year outcomes analysis. Orbit. 2015; 34(3): 115-20. https://doi.org/10.3109/01676830.2014.950286
  7. Gavriel H, Jabrin B, Eviatar E. Management of superior subperiosteal orbital abscess. Eur Arch Otorhinolaryngol. 2016; 273(1): 145-50. https://doi.org/10.1007/s00405-015-3557-1
  8. Smith TF, O’Day D, Wright PF. Clinical implications of preseptal (periorbital) cellulitis in childhood. Pediatrics. 1978; 62(6): 1006-9.
  9. Kinis V, Ozbay M, Bakir S, et al. Management of orbital complications of sinusitis in pediatric patients. J Craniofac Surg. 2013; 24(5): 1706-10. https://doi.org/10.1097/SCS.0b013e3182a210c6
  10. American Academy of Pediatrics. Subcommittee on management of sinusitis and committee on quality improvement. Clinical practice guideline: Management of sinusitis. Pediatrics. 2001; 108(3): 798-808. https://doi.org/10.1542/peds.108.3.798
  11. Gavriel H, Yeheskeli E, Aviram E, Yehoshua L, Eviatar E. Dimension of subperiosteal orbital abscess as an indication for surgical management in children. Otolaryngol Head Neck Surg. 2011; 145(5): 823-7. https://doi.org/10.1177/0194599811416559
  12. Oxford LE, McClay J. Medical and surgical management of subperiosteal orbital abscess secondary to acute sinusitis in children. Int J Pediatr Otorhinolaryngol. 2006; 70(11): 1853-61. https://doi.org/10.1016/j.ijporl.2006.05.012
  13. Ryan JT, Preciado DA, Bauman N, et al. Management of pediatric orbital cellulitis in patients with radiographic findings of subperiosteal abscess. Otolaryngol Head Neck Surg. 2009; 140(6): 907-11. https://doi.org/10.1016/j.otohns.2009.02.014
  14. Soon VTE. Pediatric subperiosteal orbital abscess secondary to acute sinusitis: A 5-year review. Am J Otolaryngol. 2011; 32(1): 62-8. https://doi.org/10.1016/j.amjoto.2009.10.002
  15. Tabarino F, Elmaleh-Bergès M, Quesnel S, Lorrot M, Van Den Abbeele T, Teissier N. Subperiosteal orbital abscess: Volumetric criteria for surgical drainage. Int J Pediatr Otorhinolaryngol. 2015; 79(2): 131-5. https://doi.org/10.1016/j.ijporl.2014.11.021
  16. Rahbar R, Robson CD, Petersen RA, et al. Management of orbital subperiosteal abscess in children. Arch Otolaryngol Head Neck Surg. 2001; 127(3): 281-6. https://doi.org/10.1001/archotol.127.3.281
  17. Todman MS, Enzer YR. Medical management versus surgical intervention of pediatric orbital cellulitis: The importance of subperiosteal abscess volume as a new criterion. Ophthalmic Plast Reconstr Surg. 2011; 27(4): 255-9. https://doi.org/10.1097/IOP.0b013e3182082b17
  18. Eviatar E, Gavriel H, Pitaro K, Vaiman M, Goldman M, Kessler A. Conservative treatment in rhinosinusitis orbital complications in children aged 2 years and younger. Rhinology. 2008; 46(4): 334-7.
  19. Harris GJ. Subperiosteal abscess of the orbit: older children and adults require aggressive treatment. Ophthalmic Plast Reconstr Surg. 2001; 17(6): 395-7. https://doi.org/10.1097/00002341-200111000-00002
  20. Spires JR, Smith RJ. Bacterial infections of the orbital and periorbital soft-tissues in children. Laryngoscope. 1986; 96(7): 763-7. https://doi.org/10.1288/00005537-198607000-00012
  21. Froehlich P, Pransky SM, Fontaine P, Stearns G, Morgon A. Minimal endoscopic approach to subperiosteal orbital abscess. Arch Otolaryngol Head Neck Surg. 1997; 123(3): 280-2. https://doi.org/10.1001/archotol.1997.01900030054006
  22. Tanna N, Preciado DA, Clary MS, Choi SS. Surgical treatment of subperiosteal orbital abscess. Arch Otolaryngol Head Neck Surg. 2008; 134(7): 764-7. https://doi.org/10.1001/archotol.134.7.764