Офтальмохирургия (Dec 2015)
THE SURGICAL TREATMENT OF THE SUBPERIOSTEAL ABSCESS OF THE LOW ORBITAL WALL
Abstract
Purpose. Optimization of surgical treatment of the odontogenic subperiosteal abscess (SPA) of the low orbital wall. Material and methods. From 2000 to 2012 the odontogenic SPA of the low orbital wall was diagnosed in 13 patients aged from 13 to 64: male 6, female 6, children 1. There were applied the multyspiral computed tomography, the magnetic resonance angiography of the orbit, paranasal sinuses, brain and were found: an exudative detachment of periosteum, destruction of the low bone wall of orbit, exudate in the paranasal sinuses, throm bophlebitis of orbital veins. Results. The sources of SPA were purulent periodontitis, extraction of tooth with formation fistula into maxillary sinus, sinusitis. Infection of the odontogenic origin penetrate into orbit by contact and hematogenic ways simultaneously with the development of SPA, thrombophlebitis of veins of orbit, pterygopalatine fossa (5), thrombosis of cavernous sinus (4), sepsis (E.coli, St.aureus).11 (84,6%) out of 13 patients with the odontogenic SPA against the background antibiotic therapy were operated on: «single–stage subperiosteal and supraperiosteal orbitotomy by transcutaneous approach along ciliary border of inferior eyelid» (patent for invention № 2370247 from 20.10.2009). At the same time maxillaryethmoidotomia, operative exploration of maxilla, drainage pterygopalatine fossa were performed. 2 patients were given the wrong admission diagnosis – orbit phlegmon, which led to inadequate treatment, reoperations. Conclusion. The innovated operation turned to be highly effective in 90% of patients, it made possible to exclude repeated surgical operations, to receive clinical recovery within 12-18 days with good cosmetic effect, preservation of visual functions. In one case lethal outcome was observed, but the patient with brain abscess was hospitalized too late.
