Orbital Subperiosteal Abscess Drainage: Transorbital vs. Endonasal Approach

<b>Background</b>: This study aims to compare the surgical outcomes of transorbital versus endonasal endoscopic approaches for orbital subperiosteal abscess drainage. <b>Methods</b>: A retrospective review was conducted at a single institution of patients who underwent orbital subperiosteal abscess drainage from November 2009 to April 2023. <b>Results</b>: Of 64 patients, 44 (68.8%) underwent abscess drainage via an orbital approach, while 20 (31.3%) underwent endonasal endoscopic drainage. No significant difference in operative time or visual acuity improvement was found between the two groups. Abscess drainage via orbitotomy was associated with a longer total (average 8.1 days) and postoperative (average 7.3 days) hospitalization time compared to the endoscopic group (average 5.4 days and 4.2 days, respectively), though this difference was not statistically significant (<i>p</i> = 0.197, 0.136, respectively). For medial orbital abscesses, the average length of total and postoperative hospitalization was greater after orbitotomy (<i>p</i> = 0.028 and 0.019, respectively). At discharge, patients who underwent orbitotomy more commonly reported periorbital swelling (<i>p</i> = 0.0003), while postoperative pain was more common in the endoscopic drainage group (<i>p</i> = 0.009). Reoperation rate was higher after orbitotomy (34.1%) compared to the endoscopic drainage group (15.0%), though this was not statistically significant (<i>p</i> = 0.115). <b>Conclusions</b>: Transorbital and endoscopic surgical approaches for orbital abscess drainage have similar surgical outcomes, with no statistically significant differences noted in terms of visual acuity change or reoperation rate. Longer hospital stays were found for patients with medial orbital abscesses drained via orbitotomy.