Treatment of Nasal Septum Abscess
The treatment of nasal septal abscess requires immediate surgical drainage combined with parenteral broad-spectrum antibiotics to prevent potentially life-threatening complications and cosmetic deformity. 1
Diagnosis and Clinical Presentation
Common symptoms:
- Nasal pain
- Nasal obstruction
- Fever
- Swelling of the nasal septum
Risk factors:
- Nasal trauma (most common cause)
- Acute sinusitis
- Uncontrolled diabetes mellitus
- Immunocompromised state
Treatment Algorithm
1. Immediate Surgical Management
- Surgical drainage is the cornerstone of treatment 1, 2
- Incisional drainage or needle aspiration to evacuate purulent material
- Collection of specimens for culture and sensitivity testing
- For solid, tumor-like presentations, surgical excision may be necessary 3
2. Antimicrobial Therapy
Initiate parenteral broad-spectrum antibiotics immediately after obtaining cultures 1
Initial empiric coverage should include:
- Coverage for Staphylococcus aureus (most common pathogen)
- Coverage for MRSA, especially in at-risk patients
- Coverage for anaerobic bacteria (particularly if oral flora involvement is suspected) 4
Recommended empiric antibiotic regimens:
Duration: Typically 5-7 days of parenteral antibiotics, followed by oral therapy based on culture results 5
3. Septal Reconstruction
- Immediate reconstruction of the destroyed nasal septum in the acute phase is recommended to prevent short and long-term nasal deformities 2
- Options include:
- Homologous bank cartilage implantation
- Mosaic plastic using small pieces of residual septal cartilage assembled with fibrin glue 2
Special Considerations
Pediatric Patients
- Nasal septal abscess in children requires particular attention due to potential impact on facial growth and development 6, 2
- Immediate drainage and reconstruction are critical to prevent saddle nose deformity 2
Complications if Untreated or Inadequately Treated
- Intracranial complications (meningitis, brain abscess, cavernous sinus thrombosis) 4, 1
- Saddle nose deformity (cosmetic and functional impairment) 1
- Septal perforation
- Impaired nasal growth (especially in children) 2
Follow-up Care
- Close monitoring for at least 24-48 hours after drainage
- Regular follow-up for at least 1 year to monitor for development of saddle nose deformity 1
- Evaluation of nasal patency and cosmetic outcomes
Pitfalls to Avoid
- Delaying surgical drainage can lead to cartilage necrosis and subsequent deformity
- Inadequate antibiotic coverage, particularly failing to cover MRSA when indicated
- Failure to recognize and treat the underlying cause (e.g., sinusitis, trauma)
- Not considering immediate septal reconstruction, which may lead to long-term cosmetic and functional deficits
The combination of prompt surgical drainage, appropriate antibiotic therapy, and immediate septal reconstruction offers the best chance for complete resolution without long-term sequelae.