Subperiosteal abscess

Introduction to subperiosteal abscess The clinical situation of the subperiosteal abscess (subperiostealabscessoftheorbit) is similar to that of sputum cellulitis, which has certain difficulties in the identification of the two. With the wide application of modern imaging technology, especially CT scanning, the subperiosteal abscess is gradually recognized, and its discovery rate is gradually increasing. The incidence of subperiosteal abscess is not less than that of cellulitis. The infection is located in a relatively avascular, ineffective cavity, and there is some debate about its treatment. basic knowledge The proportion of illness: 0.001% Susceptible people: no specific population Mode of infection: non-infectious Complications: eyeballs

Causes of subperiosteal abscess

(1) Causes of the disease

Sinusitis is the main pathogenic factor. Subperiosteal abscess is sometimes associated with cold. It can cause sinusitis due to cold. Adult subperiosteal abscess is related to ethmoid sinus, maxillary sinus and frontal sinus. The pathogen is often streptococcus, staphylococcus, pneumonia. Diplococcus, Haemophilus influenzae and anaerobic bacteria.

(two) pathogenesis

Inflammation causes sinus occlusion, bacterial proliferation, decreased oxygen tension, anaerobic flora growth, bacteria and inflammatory products diffuse directly through the weak bone plate between the eyelid and sinus to the periosteum, because the periosteum is at the rim, the tip and On the sputum, the lower fissure is tightly attached, and the sacral wall is loosely attached. The pus easily picks up the periosteum and forms an abscess. It occurs only after the frontal sinus is 5 to 7 years old, and develops completely until puberty; under the periosteum within 10 years old The abscess is mostly from the ethmoid sinus and maxillary sinus.

Subperiosteal abscess prevention

Caused by a large number of causes, in order to prevent the occurrence of the disease, early treatment of various primary suppurative sources. Do not squeeze the swelling of the "dangerous triangle" of the face, otherwise it may lead to the occurrence of this disease. Once it happens, you should go to the hospital as soon as possible, early diagnosis, early treatment, and good prognosis. In some villages, some patients often use traditional Chinese medicine for external application, delay treatment, make the condition worse, seriously impair vision, and even appear serious post-complication, should be taken as a warning.

Subperiosteal abscess complications Complications

Axillary syndrome and so on.

Subperiosteal abscess symptoms Common symptoms Nasal congestion, fever, abscess, edema, dizziness, sputum, drooping, eyeball

General malaise, fever, nasal congestion and other symptoms of upper respiratory tract infection, conscious headache, discomfort, fever, cough, runny nose or stuffy nose, eye pain, eyelid swelling and swelling caused by ptosis, cleft palate become smaller, and some may be at the gingival margin Fluctuating mass, conjunctival congestive edema, prominent in the cleft palate, due to inflammation and soft tissue in the iliac crest, especially similar extraocular muscles, so the eyeball is prominent, eye movement is limited, subperiosteal abscess caused by sphenoid sinusitis is rare Most of them are abscesses when the sphenoid sinus is combined with infection. Because the periosteum of the apex is tightly adhered to the bone wall, it is not easy to form an abscess locally. However, sphenoid sinusitis causes a large abscess and affects the visual nerve damage caused by the optic nerve. Vision loss and optic disc edema, puncture smear and bacterial culture, the positive rate is not high.

Examination of subperiosteal abscess

1. Blood routine examination can find that the total number of peripheral white blood cells is increased and the nucleus is shifted to the left.

2. Pathological examination of pus for necrotic cell debris, exudate and polymorphonuclear leukocytes; acute abscess tissue edema, a large number of polymorphonuclear leukocyte infiltration; chronic abscess wall fibrous connective tissue, including lymphocytes and plasma cell.

3. X-ray examination revealed an increase in sinus density or gas-liquid level. In addition, fractures or foreign bodies were seen in the trauma, but subperiosteal abscess could not be diagnosed.

4. Ultrasound examination A-type ultrasound showed that the abscess was a medium-low reflex wave, the periosteum was separated from the bone wall, and it was high-wave. The B-mode ultrasound showed that the abscess was a fusiform region with clear boundary. The clear posterior boundary echo was strong and the periosteum was strong. And echogenicity of the bone wall, the special ultrasound of the ophthalmology is unclear, and high-power ultrasound can still show that color Doppler ultrasound shows achromatic blood flow in the abscess capsule, and the eyeball is deformed by pressure.

5. CT scan showed that subperiosteal abscess was superior to X-ray. Horizontal and coronal scan showed thickening of periosteum in the sacral wall, high density, fusiform or flat bulge, low internal density, and the wall of the capsule could be enhanced by ring of fortifier. Muscle displacement or mild thickening, at the same time showing increased density in the sinus, or missing sacral bone. For subperiosteal abscess caused by traumatic foreign body, fractures or foreign bodies can be found at the same time. Horizontal scanning shows good appearance on the inner and outer wall abscesses. Coronal scans are superior to horizontal scans in wall and inferior wall abscesses.

6. MRI manifested as fusiform lesions. Due to the presence of water and necrotic tissue in the abscess, T1WI showed a medium-low signal, T2WI was a medium-high signal, and showed extraocular muscle changes and sinus lesions. The wall of the capsule could be Gd-DTPA. strengthen.

Diagnosis and diagnosis of subperiosteal abscess

Diagnostic criteria

The white blood cells in the surrounding blood rise and the nucleus moves to the left.

Patients with colds, fever, dizziness, nasal congestion, elevated white blood cells; orbital conjunctival edema, ocular protrusion, blepharospasm and undulating masses should be considered subperiosteal abscess, but should be distinguished from sputum cellulitis and sputum abscess, so X-ray films, eyelid ultrasound and CT scans are important.

Differential diagnosis

In addition to systemic symptoms, the patient sees eyeballs protruding, eye movement disorders, conjunctival edema of the eyelids, may be accompanied by decreased vision, and some may touch soft masses at the temporal margin.

1. Cellulitis is similar to subperiosteal abscess in clinical practice. Some people think that cellulitis is the last stage of sinus inflammation spread to the sacral area. The inflammation first passes through the subperiosteal abscess stage. After the protection of the periosteum fails, it spreads into the sputum. Soft tissue; some people think that cellulitis treatment is not complete can form intraorbital abscess or subperiosteal abscess, but the two are not completely different in clinical pathology, subperiosteal abscess may be associated with inflammation of soft tissue, therefore, clinical manifestations have in common It is mainly to identify whether there is an abscess, and it needs to be examined by imaging, especially CT examination has more diagnostic value.

2. Mucocele is due to sinus inflammation, trauma, tumor and other reasons blocking the sinus drainage, so that mucosal secretions gather, forming cysts, the most common frontal sinus, followed by ethmoid sinus, maxillary sinus, sphenoid sinus, due to The cyst compresses the wall for a long time, the bone is absorbed, the cyst is involved in the iliac crest and the eyeball is prominent, and the sacral edge can touch the soft mass. The cyst oppresses the eyeball and produces refractive error. When the infection occurs, it can form. Mucin abscess, mucinous cyst clinical lack of acute inflammation, imaging examination of mucinous cyst X-ray showed increased sinus density, sinus enlargement, bone space disappeared and subperiosteal abscess is difficult to identify, ultrasound showed that the inner side of the sacral area is clear, the posterior boundary echo is beyond Eyelids, strong sound, compression deformation, CT found increased density in the sinus, sinus cavity enlargement, sacral wall disappeared, high-density lesions invaded the eyelids, the boundary is clear, the normal structure of the sac is displaced, after intravenous injection of contrast agent, the wall Ring enhancement, while the internal density is not enhanced, MRI lesions are medium signal on T1WI, T2WI is high signal, puncture fluid is mucus, when accompanied by infection Neutral leukocytes, histopathological examination to see wall pseudostratified columnar ciliated epithelium, respiratory tract mucosa epithelium.

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