Hematoma and abscess of the nasal septum

in children.
Canty PA1, Berkowitz RG.

Author information
Abstract
OBJECTIVE:
To evaluate the clinical characteristics and treatment outcome of hematoma and abscess of
the nasal septum (HANS) in children.
DESIGN:
Retrospective case series.
SETTING:
Pediatric tertiary care facility.
PATIENTS:
Consecutive series of 20 children (age, 2 months to 15 years; mean age, 7 years) who were
admitted to the hospital for treatment of HANS after nasal trauma during an 18-year period.
INTERVENTIONS:
In addition to receiving antibiotics, all patients underwent general anesthetic for incision and
evacuation of the collection of blood and pus together with nasal packing.
RESULTS:
All patients had a history of nasal trauma. The HANS was a consequence of child abuse (2
patients younger than 2 years), minor nasal trauma (14 patients aged 1 to 10 years), and
sports injury (4 patients older than 10 years). The diagnosis was made 1 to 14 days (mean, 5.9
days) after the episode of trauma. Nasal obstruction was the most common symptom found
and was present in all but 1 patient. Pain, rhinorrhea, and fever occurred in 50%, 35%, and
25% of patients, respectively. Nasal fracture was present in 3 children. Abscess was found at
surgery in 12 patients and was universally associated with septal cartilage destruction.
Hematoma was present in 8 patients and associated with cartilage destruction in 2 patients.
Organisms cultured were Staphylococcus aureus, Streptococcus pneumoniae, and group A
beta-hemolytic streptococcus and were obtained from all 12 patients with septal abscess and
from 1 patient with septal hematoma. Corrective nasal surgery has been performed in 5
patients, 4 of whom had a history of septal abscess.
CONCLUSION:

The diagnosis of HANS must be considered in all children who have acute onset of nasal
obstruction and a history of recent nasal trauma to minimize the risk of nasal deformity and
prevent the development of septic complications.
http://www.ncbi.nlm.nih.gov/pubmed/8956753

[Treatment of the nasal septal hematoma

and abscess in children].
[Article in Polish]
Zielnik-Jurkiewicz B1, Olszewska-Sosiska O, Rapiejko P.

Author information
Abstract
OBJECTIVES:
Estimation of the treatment of the nasal septal hematoma and abscess after injury was
performed.
MATERIAL AND METHODS:
In 1998-2005 in Department of Otolaryngology Children's Hospital in Warsaw 2500 children
after nasal injury were examined. Nasal septal hematoma and abscess were diagnosed in 22
(0,9%). They were reviewed retrospectively and some of them were examined 1-8 years after.
RESULTS:
In 22 children with nasal septal hematoma and abscess no complication were observed during
treatment. In 12 children examined 1-8 year after treatment 1 child developed saddle nose
deformity (qualified to observation) and 1 child developed nasal septum deformities with
nasal obstruction (qualified to septoplasty).
CONCLUSIONS:
Complex treatment of nasal septal hematoma, drainage of the hematoma with septoplasty and
reduction of fracture of the nose, makes good functional and cosmetic effect. Drainage of the
nasal septal abscess with antibiotic prevent the early complications but it isn't enough
functional and cosmetic effect in the future.
http://www.ncbi.nlm.nih.gov/pubmed/18637425

Nasal septal abscess in children:

reconstruction with autologous cartilage
grafts on polydioxanone plate.
Menger DJ1, Tabink IC, Trenit GJ.

Author information
Abstract
OBJECTIVE:
To assess outgrowth and aesthetics of the nose in children after reconstruction of the
cartilaginous nasal septum with autologous cartilage grafts on polydioxanone plate.
DESIGN:
Prospective nonrandomized case series.
SETTING:
University hospital.
PATIENTS:
Six patients (5 boys and 1 girl), aged 3 to 11 years, with nasal septal abscess.
INTERVENTION:
The nasal septa of 6 children with a history of nasal septal abscess and partial or complete
destruction of nasal septal cartilage were reconstructed with autologous cartilage grafts of the
auricle or rib fixed on polydioxanone plate.
MAIN OUTCOME MEASURES:
Nasal outgrowth was measured by the length of the nose and by the amount of nasal tip
projection and was compared with standardized growth curves. Aesthetic outcome variables
included nasolabial angle, columellar retraction, and development of saddle nose deformity
and were classified as normal, mild, or severe.
RESULTS:
The duration of follow-up ranged from 10 to 68 months (mean follow-up, 38 months). Four
children had complete loss of the cartilaginous septum. Areas 1 and 2 (caudal parts) had been
destroyed in 2 children. Auricular cartilage was used in 5 children; costal cartilage was
needed in 1 child. Compared with standardized growth curves, the length of the nose and the
amount of nasal tip projection were within 1 SD in all children. None of the children

developed saddle nose deformity. One child had mild columellar retraction; 3 children had
mild overrotation of the nasal tip.
CONCLUSION:
Total reconstruction of abscess-induced destruction of nasal septal cartilage with autologous
cartilage grafts fixed on polydioxanone plate has, so far, resulted in normal development of
the nose during follow-up, without expected aesthetic problems.
http://www.ncbi.nlm.nih.gov/pubmed/18711058

Int J Pediatr Otorhinolaryngol. 2011 Jun;75(6):737-44. doi: 10.1016/j.ijporl.2011.03.010.

Epub 2011 Apr 14.

Nasal septal abscess in children: from

diagnosis to management and prevention.
Alshaikh N1, Lo S.

Author information
Abstract
BACKGROUND:
Nasal septal abscess (NSA) is an uncommon condition. It is a collection of pus in the space
between the nasal septum and its overlying mucoperichondrium and/or mucoperiosteum. If
left untreated, there are risks of intracranial complications, facial deformity, and delayed
facial growth. There is no universally agreed consensus on the treatment of this condition.
This study reviews evidence in the literature to determine its etiology, presentation,
investigation, management options, and outcome.
METHOD:
A structured review of the PubMed, EMBASE and the Cochrane Collaboration databases
(Cochrane Central Register of Controlled Trials, Cochrane Database of Systemic Reviews)
was undertaken, using the MeSH terms: nasal septum, nasal cartilage, trauma, hematoma,
abscess, reconstructive surgery, rhinoplasty, pediatric, and children.
RESULTS:
A total of 159 citations from 1920 to date were reviewed regarding nasal septal abscess, of
which 81 articles were identified to be relevant to this review. No randomized controlled
trials or systematic reviews were found in the Cochrane Collaboration database, PubMed or
EMBASE. NSA is more common in children and in male. Nasal trauma and untreated septal
hematoma are the leading cause. Staphylococcus aureus is isolated in up 70% of the cases.

Clinically, nasal septal swelling, pain and tenderness, with purulent discharge are mostly
evident. The immediate management of NSA is incision and drainage and antibiotic therapy.
Recent studies suggest early septal reconstruction in children in order to prevent immediate
and late facial deformity and nasal dysfunction. Autologous cartilage is the implant material
of choice.
CONCLUSION:
Nasal septal abscess is a serious condition that necessitates urgent surgical management in
order to prevent potential life threatening complications. In the growing child, early
reconstruction of destructed septal cartilage is essential for normal development of the
midface (nose and maxilla).
http://www.ncbi.nlm.nih.gov/pubmed/21492944

CASE REPORTS
Tubercular Septal Abscess
Meenakshi Singh*, Rohit Singh*, Anita P Sonsale**

Tuberculosis of nose has become so infrequent that it is virtually a forgotten disease entity among younger
practitioners in this country. Nevertheless, it can occur in all segments of our population and may present a
confusing diagnostic problem. A case is presented because of its rarity and more importantly as a reminder of
the diagnosis since despite modern chemotherapy the incidence of this disease is once again increasing.
Introduction
Granulomatous lesions within the nasal cavity may represent either local diseases or a manifestation of a systemic
disorder. In any of the situation differential diagnosis must include tuberculosis. Nasal involvement of this condition
was first described in Venice by Giovanni Morgagni in 17611 but it was not until 1876 that primary nasal disease was
2
described by Clarke in an address to the pathological society of London.
Case Report

A 52 year old female presented to ENT/OPD with chief complaint of nasal blockage since one month, which was
progressively increasing. There was no history of trauma, epistaxis, mucopurulent rhinorrhoea, visual disturbance and
pain over the face. She was diagnosed diabetic and hypothyroid three months back. She had supraclavicular lymph
node biopsy, two months back. The histopathology of lymph node was tubercular and she was on Anti tubercular
therapy since then. HRCT of chest was done at that time which showed mediastinal, bilateral hilar and left
supraclavicular (Fig. 1) lymphadenopathy with subtle sub pleural and peri bronchovascular nodules. Rest of the pleural
space and bony cage were normal. On clinical examination there was swelling of the dorsum of the nose, anterior
rhinoscopy showed bulge in the septum which was prominent on both the sides. Overlying muco perichondrium was
normal, no ulcer/erosion seen and postnasal space was apparently normal. CT scan of paranasal sinuses revealed
septal bulging with breach in continuity of anterior end of septum (Fig. 2). Posterior part of septum was absolutely
normal (Fig. 3). At the time of admission WBC count was 8.740, neutrophils 79% and ESR was 90 mm/hr. Incision and
drainage was done under local anaesthesia in view of medical condition. I and D revealed minimal seropurulent
discharge. The mucoperichondrium was thickened with lots of granulation tissue. Quadrangular cartilage was thinned
out. Granulation tissue alongwith the cartilage were removed and sent for histopathological examination. Seropurulent
discharge was sent for bacterial culture, sensitivity and fungal smear.
Histopathology showed inflamed granulation tissue with Langhans cell and necrosis, well defined granuloma was
seen (Fig. 4). No definite vasculitis was seen. PAS and GMS stains were negative for fungal elements. Smear and
culture was positive for Acid Fast Bacilli which confirmed the diagnosis as tubercular abscess. Fungal smear and
culture sensitivity was negative. ANCA the diagnosis as tubercular abscess. Fungal smear and culture sensitivity was
negative. ANCA was also negative. Patient was continued with AKT and discharged. Continuous follow up was done
upto one year and patient was completely cured with no recurrence.
Discussion

Nasal septal abscess is defined as a collection of purulent material between the cartilage or bony septum and its
mucoperichondrium or mucoperiosteum. Most patients have a history of trauma which may be accidental or iatrogenic.
Spontaneous septal abscesses are rare, acute ethmoiditis, sphenoiditis and dental infection have been mentioned as
cause.

Fig. 1 : HRCT chest showing bilateral hilar and peribronchovascular nodules

Fig. 2 : CT of PNS showing anterior septal bulging

Fig. 3 : CT of PNS showing normal posterior part of

septum

Primary nasal tuberculosis is extremely rare, indeed any nasal involvement is uncommon but in over 75 per cent of
3
4
cases represents a manifestation of generalized disease. It is predominantly seen in females and usually in elderly.
These lesions tend to occur on the lateral nasal wall, septal involvement is rare. Primary nasal disease is not thought
to be particularly contagious. Tuberculosis of the upper respiratory tract and nasopharyngeal region has been
observed mainly in patients with active pulmonary tuberculosis. Smoking and low socio economic status were also
reported as risk factors. Nasal obstruction, rhinorrhoea, epistaxis and snoring are known symptoms of nasal
tuberculosis. Some times patients may be totally asymptomatic when associated with nodal disease and only
diagnosed by histological diagnosis. Pulmonary kochs should be excluded by chest X-ray.

In our case, the only positive examination finding was

broadening of the dorsum of nose and bulging septum with no
signs of active infection.
X-ray chest of the patient was normal but repeat HRCT chest
showed hilar lymphnode enlargement, however left supra
clavicular node had resolved following AKT.

Fig. 4 : Histopathology of granulation tissue from

nasal septal cartilage showing granuloma with
Langhans cell

The drug therapy for nasal tuberculosis is the same as for

generalized condition and should be undertaken by or at least in
conjunction with a chest physician. This is especially relevant as
5
the rate of drug resistant mycobacteria is rising. The surgical
debridement is essential for diagnosis and clearance. Delayed
management of septal abscess can result in compromise of the
vascular supply to septal cartilage resulting in its ischaemic
necrosis and saddle shaped deformity of the nose. Other
complications of septal abscess documented include sepsis,
bacteraemia, meningitis and maxillary hypoplasia.

Initially the rise was blamed on the emerging problem relating to human immuno deficiency virus infection, but it is now
recognised to be multifactorial in origin including socio economic deprivation, immigration and previous under
6
reporting. HIV must be considered in all cases of tuberculosis as between five to ten per cent of immuno
7
compromised patients are infected by mycobacteria species. Hence, in order to avoid unnecessary complications,
which can be fatal to the patient, diagnosis should be accurate and treatment prompt.
References
1. Morgagni G. On the seats and causes of death investigated by anatomy. Venice; 1761; 1 : 50-5.
2. Clarke W. Tuberculous lupus of the tongue palate and gums. Transactions of the Pathological Society (London)
1876; 27 : 240-9.
3. Waldman S, Levine H, Sebek B, Parker W, Tucker H. Nasal tuberculosis: a forgotten entity: Laryngoscope 1981; 91
: 11-6.
4. Friedmann I. The changing pattern of granulomas in the upper respiratory tract. Journal of Laryngology and Otology
1971; 85 : 631-77.

5. Johnson IJM, Soames JV, Marshall HF. Nasal tuberculosis - an increasing problem. The Journal of Laryngology and
Otology 1995; 109 : 326-7.
6. Ormerodo L. Tuberculosis in the 1990s. Hospital Update 1761; 20 : 363-8.
7. Helbert M, Robinson D, Buchanan D, Hellyer T, McCarthy M. Mycobacterial infection in patients infected with the
human immunodeficiency virus. Thorax 1990; 45 : 45-8.

PREVENTING FALLS MAKES HOSPITAL STAY SAFER

A multiple intervention programme to prevent falls can make in-hospital stay safer for patients. Reducing falls
in elderly patients admitted to hospital will benefit the patients and reduce additional costs.
BMJ, 2004; 328 : 676.

http://bhj.org.in/journal/2004_4602_april/html/tubercular_243.htm

MyPACS.net: Radiology Teaching Files > Case 48507567

NASAL SEPTAL ABSCESS
Contributed by: Jonah Moon, Resident, Northeastern Ohio Universities College of MedicineCanton Affiliated Hospitals, Ohio, USA.
History: Fever, pain, cellulitis, concern for abscess
Images:

[small]

larger

Fig. 1: Rim enhancing hypodense fluid

collection (abscess) involving the anterior nasal
septum. Infiltration of the soft tissues of the
nose

Fig. 2: Sagittal image demonstrating AP

extention of the rim enhancing hypodense
fluid collection

Findings:

Involving the anterior nasal septum, there is rim enhancing hypodense fluid collection
which measures about 2 cm in size
Diagnosis: Nasal Septal Abscess
Discussion:

Nasal septal abscesses can arise as a complication of trauma, sinonasal, and dental
infections. Usually there is some form of trauma (micro, or otherwise) and then
mucoperichondrium is separated by the cartilage. Infection can then occur. The most
common organisms include Streptococcus aureus. Less common bacterial organisms
include S. pneumoniae, S. viridans, S. epidermidis, and H. Flu. Complications include
bacteremia, sepsis, meningitis, cavernous sinus thrombosis, saddle nose deformity and

extension of the abscess to the brain.

Presenting symptoms include nasal occlusion, pain and tenderness. Systemic symtoms
include generalized malaise, fever, and headache.
References:

StatDx "Nasal Septal Abscess"

Nasal Septal Abscess in Patients with Immunosuppression, Debnam J M, AJNR 28 NovDec 2007.
Nasal septal abscess: an unusual complication of acute spheno-ethmoiditis, The Journal of
Laryngology & Otology
July 2002, Vol. 116, pp. 543545.
http://www.mypacs.net/cases/NASAL-SEPTAL-ABSCESS-48507567.html

Nasal Septal Abscess Caused by Dental

Infection: A Case Report
F zan, S Polat, H Yeler
Keywords

dental infection, nasal septal abscess

Citation

F zan, S Polat, H Yeler. Nasal Septal Abscess Caused by Dental Infection: A Case Report.
The Internet Journal of Dental Science. 2005 Volume 3 Number 2.
Abstract

Nasal septal abscesses caused by dental infection are rare. We report a case of a nasal abscess
caused by dental infection. In this manuscript development of the condition, possible
complications, and treatment are discussed.

Introduction
Nasal septal abscesses caused by dental infection were rare. Three cases were found in the
English literature. (1,2) We report a case of a nasal abscess caused by dental infection. In this
manuscript development of the condition, possible complications, and treatment are
discussed.
A nasal septal abscess (NSA) is defined as a collection of pus between the cartilage or bony
septum and its normally applied mucoperichondrium or mucoperiostium.3 NSA is a rare
entity, but, if diagnosed and attended to promptly, it can be cured with little residual
deformity of problems.4 On the other hand, neglect can lead to nasal collapse and even
cavernous sinus thrombosis.3,4,5,6
This pathology is often the result of an infected septal hematoma which can be a serious
complication of trauma or surgery.1,5The rupture of the small vessels that supply the nasal
septum forms a hematoma that separates the mucoperichondrium from the septal cartilage.
Cartilage destruction follows as a result of ischemic and pressure necrosis. The static blood
and the necrotic cartilage form an adequate medium for the growth of the bacteria which
normally colonize the nasal mucosa.3,5,7
The aim of this manuscript was presentation this rare condition, its life threatening
complications, and how to manage it.

Case Report

A 21-year-old woman presented with complaints of having something in her nose, pain, nasal
airway obstruction and swollen upper lip.
There is no history of trauma, sinusitis or surgical trauma. Two weeks prior to presentation at
our institution, the patient had had root canal filling in dental office to upper left second
incisor. A few days later after root canal therapy had been her complaint of pain, upper lip
swollen and nasal obstruction occurred.. The physical examination at presentation was
remarkable for an anterior round purplish mass in the nose which projected bilaterally form
the nasal septum (Figure 1).
{image:1}
Her upper lip and perinasal areas were swelled and tender to palpation. Periapical radiograph
was taken and it was observed that there was large periapical lesion associated with upper left
second incisor that had been root canal filling (Figure 2).
{image:2}
Under topical anesthesia aspiration was attended, but we did not get enough pus on aspiration
for microbiologic evaluation. Than she was started on 625mg amoxicillin + clavulanic acid
twice a day (Bioment Ko-Amoksiklav BID, Fako, Istanbul, Turkey) and 550 mg naproxen
sodium twice a day (Synax Fort, Biofarma, Istanbul, Turkey). Apical resection operation was
planned when her acute symptoms were resolved. Three days after started on antibiotic
regimen apical resection was made. At the operation we encountered larger apical lesion than
seen on radiography. Lesion was extended to floor of the nasal cavity, we encountered
greyish nasal mucosa. Granulation tissue was curetted and root tip excised. Pus that was
small amount was drained from operation area. Postoperatively patient was continued on
previous medication regimen for a week. At the time of suture removal nasal airway
obstruction and upper lip swollen were totally resolved (Figure 3). After 1 month the patient
showed no evidence of infection.
{image:3}

Discussion
Abscess of the nasal septum are uncommon. The most common cause is infection of an
untreated nasal septal hematoma following nasal trauma. More infrequently, nasal septal
abscess occurs following nasal surgery, furunculosis of the nasal vestibule, sinusitis,
influenza, and dental infections.5 Nasal obstruction is the most common presenting symptom
seen with NSA. Other associated symptoms include throbbing nose pain, general malaise,
fever, headache, and tenderness over the perinasal area.3,5,8 The presenting symptoms depend
on the etiology of the NSA and the earliest symptoms are
usually those of a mild upper respiratory infection. Examination of the nose usually reveals
bilateral swelling of the anterior septum that can range in color from gray to reddish purple.
The size of the swelling depends on the stage at which the patient is examined. 3
The pathophysiology of a NSA depends on the aetiology of the abscess. There are several
proposed mechanisms for the development of a NSA: (1) direct extension along the tissue

planes as seen with sinusitis; (2) infection of a septal hematoma; (3) infections of dental
aetiology; and (4) venous spread from the orbits or cavernous sinus. 3
As mentioned above a NSA can be followed by infection of the orbit or cavernous sinus by
way of the ethmoidal and ophthalmic veins.1,4,5
Piotrowski at al. reported a case of nasal septum abscess, complicated with cavernous sinus
thrombophlebitis in a four- year-old child.6 The ophthalmic and angular veins are valveless,
communicating from the danger area defined by a triangle formed from the glabella to the
corners of the mouth. The lack of valves and the intracranial communication via the
cavernous sinus predisposes this area to the spread of infection.3,5 A nasal septal abscess is
usually the result of an infected hematoma of the septum. A secondary septal abscess may be
the result of infections extending from any of the neighboring tissues. Dental infections can
reach to the septum by direct extension. Septic embolism through the bloodstream is highly
improbable but cannot be excluded. The close relationship of the incisor teeth to the nasal
floor explains the fact that an abscess arising from the central upper incisors may extend and
bulge into the nasal floor.1
Delayed diagnosis and treatment may lead to extensive destruction of the nasal skeleton. The
septal cartilage may undergo necrosis secondary to interference with its blood supply by
thrombotic vasculititis the pus separates the mucoperichondrium from the cartilage, causing
ischemic necrosis, followed by further lysis by the bacteria. The lost cartilage is replaced with
fibrous tissue that may scar and later lead to unorganized asymmetric contractions that will
result in obstructive nasal symptoms.1,3,5
Necrosis of the septal cartilage leads to septal deformity, perforation, and saddle nose
deformity.1,3,5 Prevention of serious complications can be achieved only by prompt and
effective surgical treatment. Different authorities advocate almost same treatment methods, as
well antibiotic coverage, incision, drainage and packing.1,3,4,5,9 Antibiotic treatment has to be
given immediately to prevent bacteriemia, which will occur on manipulation of a mature
abscess. Most often choice of antibiotic is Penicillin. Evaluation of aspiration samples reveals
factor pathogenic organism which is usually Staphylococcus.1,5 Less often, it may be
Streptococcus pneumonia or -hemolytic Streptococcus.1 An incision across the swelling is
made as near as possible to the floor of the nose to prevent pocketing of the pus. Necrotic
tissue and cartilage, granulations, and blood clots are removed. Drainage is provided by
Penrose drain sutured in the incision. The packing serves both as a stent for the nasal skeleton
and septum. It prevents reaccumulation of blood and pus.1,3,4,5 Mostly treatment protocol
depends on infection's source.
Our treatment protocol is different from others. Since little amount of pus was observed and
granulation tissues were curetted totally, extraoral drainage found unnecessary. However, the
mass in the nose reduced significantly just after operation. There was no reaccumulation at
the follow examinations. In our case usage of antibiotic and remove of source of infection
seemed to be enough for treatment protocol because of uneventful healing.
References
1. da Silva M, Helman J, Eliachar I, Joachims HZ. Nasal septal abscess of dental origin. Arch
Otolaryngol 1982;108:380-1.
2. Chopra S, Desai NT. Nasal septal abscess due to infection from upper incisors. J Indian Dent Assoc

1969;41:249-50.
3. Rafael Santiao, Villalonga P, Maggioni A. Nasal Septal Abscess: A Case Report. Int Pediatr.
1999;14:229-31
4. Bennett J, Rapado F. Nasal septal abscess in a healthy, non-immuno compromised patient.
Hospital Medicine January 1998;59:78
5. Matsuba H, Thawley SE. Nasal Septal Abscess: Unusual Causes, Complications, Treatment, and
Sequelae. Ann Plast Surg 1986;16:161-6
6. Piotrowski S, Augustyniak M, Bojarska D, Mielniczak K. Cavernous sinus thrombosis-complicaton
of nasal septum abscess in children. Wisd Lek. 1994;47:155-7
7. Dispenza C, Saraniti C, Dispenza F, Caramanna C, Salzano FA. Management of nasal septal abscess
in childhood: our experience. Int J Pediatr Otorhinolaryngol. 2004 68:1417-21
8. Cuddihy PJ, Srinivasan V. An unusual presentation of a nasal septal abscess. J Laryngol Otol.
1998;112:775-6
9. Ambrus PS, Eavey RD, Baker AS, Wilson WR, Kelly JH. Management of nasal septal abscess.
Laryngoscope 1981;91:575-82

{full_citation}

https://ispub.com/IJDS/3/2/5293

SEPTAL ABSCESS
Submitted by cj on Sun, 10/05/2008 - 14:34.

Nose Surgeries

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This picture depicts a nose with a swelling of the middle partition or septum due to an
abscess. Nasal obstruction is the most common presenting symptom seen with septal abscess.
Others include nose pain, general malaise, fever, headache, and tenderness over the nose. The
presenting symptoms depend on the cause. A history of trauma can usually be elicited.
Staphylococcus aureus is the most common organism. Streptococcus pneumoniae,
Streptococcus milleri, Streptococcus viridans, Staphylococcus epidermis, Haemophilus
influenzae are found occationally. There are several proposed mechanisms for the
development of a septal abscess. (1) direct extension along the tissue planes as seen with
sinusitis; (2) infection of a septal hematoma; (3) infections of dental etiology; and (4) venous
spread from the orbits or cavernous sinus. Nasal septal abscess usually occurs secondary to a
nasal hematoma. There is usually an inciting traumatic event, ranging from major trauma,
including child abuse and nasal septoplasty, to less traumatic and forgotten events such as
falling off a bicycle or bumping heads during play. The rupture of the small vessels that
supply the nasal septum form a hematoma that separates the mucoperichondrium from the
septal cartilage. Cartilage destruction follows as a result of ischemic and pressure necrosis.

Blood forms a medium for bacterial growth and subsequent abscess formation.The initial
treatment usually consists of fine needle aspiration of the hematoma or abscess under topical
anesthesia. The aspirate is sent for gram stain, culture and sensitivity. Intra venous antibiotic
should be started.The most common pathogen involved is S aureus, thus a semisynthetic
penicillin is a reasonable choice. In patients who are allergic to penicillin, vancomycin can be
used. After antibiotics have been started, the next step in management is incision and
drainage. The hematoma or abscess should be evacuated to relieve the pressure and restore
blood flow. Intravenous antibiotics should be continued for 3 to 5 days and if the patient
exhibits a favorable response then it is reasonableto switch to oral antibiotics. Oral antibiotics
should be continued for 7 to 10 days. The complications of a septal abscess include
meningitis, saddle nose deformities, sepsis, bacteremia, and in younger patients maxillary
hypoplasia. Meningitis, sepsis, and bacteremia can result from vascular, lymphatic, or direct
spread through tissue planes.

Symptoms of ABSCESS OF
NASAL SEPTUM
View symptom groups below that present with ABSCESS OF
NASAL SEPTUM

Nose
painful red lump just within the nose
lump may spontaneously drain pus

Nose
nasal pain
pain over cheeks behind or above eyes
nasal discharge
headache
sore throat