Nasal septal abscess: An unusual complication of nasal trauma

doi:10.1016/0735-6757(93)90109-O

The American Journal of Emergency Medicine

Volume 11, Issue 2, March 1993, Pages 149-150

https://doi.org/10.1016/0735-6757(93)90109-O Get rights and content

Abstract

Injuries to the nasal septum may occur as a result of injuries to the nose. A case of nasal septal abscess, an unusual complication of nasal trauma, is presented. The pathophysiology, clinical course, and treatment of this disorder are discussed. This case demonstrates the need for careful evaluation of the nasal septum in all cases of nasal trauma.

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There are more references available in the full text version of this article.

Cited by (13)

Infection in the Craniomaxillofacial Trauma Patient
2015, Head, Neck, and Orofacial Infections: An Interdisciplinary Approach
Management of Soft Tissue Injuries
2012, Oral and Maxillofacial Trauma
Nasal septal abscess in children: From diagnosis to management and prevention
2011, International Journal of Pediatric Otorhinolaryngology
Citation Excerpt :
Clinically, it can be difficult to distinguish between hematoma and septal abscess. Generally, NSA is larger, more painful; the overlying mucosa may be inflamed and covered with exudates, and frequently accompanied by fever and leukocytosis [52]. In cases with no history of nasal injury, inquiry about preceding upper respiratory tract infection, dental symptoms, and recent nose, sinus, or dental procedures is important in detecting the underlying etiology.
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.
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.
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.
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).
Post-traumatic haematoma and abscess in the nasal septa of children
2008, Acta Otorrinolaringologica Espanola
El hematoma septal tras traumatismo nasal es una complicación que de no ser diagnosticada y tratada precozmente puede evolucionar a un absceso septal. Presentamos el caso de un varón de 10 años que sufrió traumatismo nasal con fractura de huesos propios y un hematoma septal que no fue diagnosticado, y cuya evolución fue un absceso septal. Durante el drenaje de este absceso se evidenció una necrosis del cartílago cuadrangular. Posteriormente el paciente presentó un hundimiento del dorso nasal y una desviación del tabique nasal. Esta secuela se corrigió mediante la utilización de un injerto osteocondral costal. Ante cualquier traumatismo nasal es importante explorar correctamente el tabique nasal para descartar un hematoma, que si no se drena de forma precoz, puede evolucionar a un absceso por compresión del cartílago cuadrangular, cuyas consecuencias son su necrosis en pocos días y posterior hundimiento del dorso nasal en el curso del desarrollo del niño.
Septal haematoma following nasal trauma is a complication that, if not diagnosed and treated early, may evolve into a nasal septal abscess. We present the case of a 10-year-old male who suffered nasal trauma with fracture and an undiagnosed septal haematoma that evolved into a septal abscess. During drainage of the abscess, necrosis of the quadrangular cartilage was noted. The patient later presented collapse of the nasal dorsum and deviation of the nasal septum. This sequela was corrected by means of an osteochondral costal graft. In the presence of any nasal trauma, it is important to explore the nasal septum correctly to discard the presence of a haematoma which, if not drained early, may evolve into an abscess due to compression of the quadrangular cartilage, leading to its necrosis in a few days and later collapse of the nasal dorsum as the child grows.
Management of nasal septal abscess in childhood: Our experience
2004, International Journal of Pediatric Otorhinolaryngology
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 neighbouring tissues.
The necrosis of septal cartilage may lead to nasal deformities and severe impairment of nasal patency and growth.
Assess if the drainage of the abscess and the immediate reconstruction of the destroyed nasal septum in the acute phase is the best treatment to prevent short- and long-term effect on nasal and midface growth.
Three pediatric patients treated with drainage and immediate implantation of homologous bank cartilage prior to 1990 and four treated with mosaic plastic using small pieces of residual septal cartilage assembled with fibrin glue.
No complication were observed in the follow-up and any deformities in the long-term controls.
The drainage and immediate reconstruction of the nesal septum are the golden standard in the treatment of the septum infected haematoma.
Nasal septal haematoma with abscess: An unusual complication of nasal injury
2004, Injury Extra

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Brief reportNasal septal abscess: An unusual complication of nasal trauma

Abstract

Int J Pediatr Otorhinolaryngol

Emerg Med Clin North Am

Int J Pediatr Otorhinolaryngol

Nasal septal abscess

Can Med Soc J

Nasal septal abscess: Unusual causes, complications, treatment and sequelae

Ann Plast Surg

Management of nasal septal abscesses

Laryngoscope

Brief report
Nasal septal abscess: An unusual complication of nasal trauma