항생제 치료로 완치된 안와 골막하농양 환자의 특징

Background and Objectives: Traditional therapeutic approach for orbital subperiosteal abscess secondary to acute sinusitis has been surgery when there is definite evidence of abscess radiologically. But there is increasing evidence that more cases have been managed nonsurgically with equal success. We hypothesized that patients who can be managed without surgery have identifiable features that may aid in predicting response to medical therapy. Materials and Method: Retrospective chart review was performed on twenty-three patients admitted betweeen 1993 and 2004 with orbital subperiosteal abscess identified on CT scan. Patients were divided into two groups: the first with successful management without surgery and the second who recieved surgery. Several parameters were compared between the two groups to identify the features that determine the therapeutic approach. Results: Fourteen patients were classified into the first group and nine in the second group. All patients in both groups were started with intravenous antibiotics and had serial ophthalmologic examinations. Statistical significance was noted in the following variables between the two groups (p<0.05): age (6.29 in the medical group vs. 16.7 in the surgical group), degree of proptosis and presense of ophthalmoplegia at presentation. All patients 10 years old or younger (n=13) were managed successfully without surgery, wheras 90% of patients 11 years old or older (n=10) needed surgery. Other variables such as sex, side of lesion, initial body temperature, WBC count, visual acuity at presentation, presense of chemosis, length of hospital stay and presense of complications showed no statistical difference between the two groups. Conclusion: An indivisualized therapeutic plan should be tailored for each patient with orbital subperiosteal abscess. An initial trial of intravenous antibiotics with close monitoring of visual acuity is appropriate especially in patients who are younger and have no gaze restriction at presentation. (J Clinical Otolaryngol 2006;17:99-105)