A case of subperiosteal abscess following trauma, triggered by nose blowing

Abstract

Intraorbital infections can lead to visual impairment and intracranial complications, which can lead to death. Thus, an early diagnosis is required to facilitate prompt surgical treatment. We encountered a patient with a subperiosteal abscess that developed after trauma, which was triggered by nose blowing. The patient was an 8-year-old girl. Her right periorbital area was injured while using a tablet device. She originally had nasal discharge and frequent nose bleeds. At the initial examination, eyelid cellulitis was observed, and a CT scan showed a fracture of the medial orbital wall, emphysema at the fracture site, and soft tissue shadow in the maxillary and ethmoid sinuses. The patient was admitted to the pediatric department, and antimicrobial therapy was started; however, during the course of treatment, the patient developed worsening eyelid swelling and vision loss. A CT scan at the time of presentation showed that the abscess was formed at exactly the same location as the fracture line and air shadow. We hypothesized that the infection spread as a result of nose blowing, ultimately leading to the development of a suborbital periosteal abscess. After emergency endoscopic rhinosinus surgery, her vision improved. There was no recurrence.