Clinical and pathological observation and treatment of chronic orbital osteomyelitis.

PURPOSE: To evaluate diagnosis, treatment, and histopathologic changes of chronic orbital osteomyelitis.

METHODS

We retrospectively analyzed the history, clinical manifestations, computed tomography (CT) scans, histopathology, treatment methods, and outcomes for 6 patients with chronic orbital osteomyelitis at the Department of Ophthalmology, West China Hospital, from January 1988 to January 2008.

RESULTS

One of the 6 patients had a history of frontal sinusitis, 4 patients had a history of trauma, and the remaining patient had a history of lateral orbitotomy. All patients had red swelling of the skin at the orbital margin, fistula formation, and pus emerging repeatedly from the fistulae. CT scans showed that sequestrum and abscess had formed in all patients. Those patients were treated by radical debridement and antibiotics with satisfactory results. Histopathologic examination showed that in 6 patients the bone trabeculae disappeared from the sequestra, abscess formed around the sequestra, and vessel dilation occurred in the areas of pathologic change with inflammatory cell infiltration. Two sequestra were completely encapsulated by fibrous connective tissue and formed involucrum.

CONCLUSIONS

Chronic orbital osteomyelitis was often found in patients with a traumatic history who had received improper or delayed treatment when injured. The main clinical features included low-grade inflammation, pus, sequestrum and fistulation. Pathologic characteristics were formation of sequestrum, abscess and involucrum. Clinical manifestations and CT scan allowed accurate diagnoses, and radical treatment using a combination of debridement and antibiotics provided satisfactory results.