[Treatment of the nasal septal hematoma and abscess in children]

Nasal septal abscess in adult patients - A single center study

PURPOSES

The purpose of this study was to present and analyze the etiologic factors, clinical manifestations, bacteriology, and treatment outcomes of nasal septal abscess in a large cohort of adult patients.

MATERIAL AND METHODS

Retrospective analysis.

RESULTS

36 adult patients, age from 19 to 85 (mean age, 51.83), with nasal septal abscesses were treated at Ear Nose Throat Hospital of Ho Chi Minh City from January 2020 to August 2022. The most common symptoms were nasal obstruction (75 %), headache/facial pain (58.33 %). Etiologic factors were found in 83.33 % of cases with the most common were diabetes mellitus (47.22 %), nose-picking (44.44 %). 75 % of cases had positive bacterial culture, of which 70.37 % were Staphylococcus aureus. Septal abscess was successfully treated in all cases using our treatment protocol, which involved an extended modified Killian's incision, irrigation with 1 % poviodine, placement of gauze in the abscess pocket, and nasal packing with Merocels.

CONCLUSIONS

Diabetes and nose-picking were the most common etiologic factors; Staphylococcus aureus was the most common organism of nasal septal abscess in our study. Our treatment protocol is safe and effective.

Nasal septal hematoma in children: Time to diagnosis and resulting complications

OBJECTIVES

To determine the time from initial injury to diagnosis of nasal septal hematoma (NSH). Additional objectives included determining number of medical evaluations prior to diagnosis and long-term complications.

METHODS

A retrospective chart review was performed on all patients diagnosed with NSH at a tertiary pediatric hospital between January 1, 2003 and April 1, 2019 were identified. Time to diagnosis was defined as time between initial trauma to date of diagnosis. Number of evaluations was defined as all medical evaluations prior to diagnosis.

RESULTS

Of 2762 charts that were reviewed, 13 patients with NSH were identified. Of those, 92% were male and trauma was the cause in 85% of patients. Median time to diagnosis was 7 days (0-21 days), with an average of 2.2 evaluations (1-4 evaluations). Settings where diagnosis were missed included EDs (N = 9, 82%), primary care (N = 6, 55%), urgent care (N = 1, 9%) and otolaryngology clinic (N = 2, 18%). Four patients (31%) were evaluated by an otolaryngologist in the ED. The median time to otolaryngology outpatient visit was 7.5 days. In five patients (46%), septal hematomas were missed in multiple clinical settings. Seven patients (54%) experienced complications, including saddle nose deformity (N = 3, 23%).

CONCLUSIONS

NSH is a rare but serious emergency. To avoid multiple visits and delay in diagnosis, additional education and awareness is needed for providers who evaluate these patients. Early diagnosis will reduce the risk of abscess formation and saddle nose deformity.

Management of Pediatric Nasal Surgery (Rhinoplasty)

Nasal surgery in children, most often performed after trauma, can be performed safely in selected patients with articulate, deliberate, and conscientious operative plan. All nasal surgery in children seeks to avoid disruption of the growth centers, preserving and optimizing nasal growth while improving the form and function of the nose. A solid appreciation of long-term outcomes and effects on growth remain elusive.

Nasal septal abscess in children: from diagnosis to management and prevention

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).