| ID | 290 |
|---|---|
| Name | ABSCESS OF THE NASAL SEPTUM |
| Cause | Causes: 1. Traumatic 2. Spontaneous. Trauma leading to submucosal haematoma formation is usually the precursor to the abscess formation. Within 72 hours, the haematoma can become infected with pus formation |
| Signs Symptoms | Fever, nasal obstruction,pain, frontal headache and enlargement of the submandibular lymph nodes. The anterior cartilaginous septum is most commonly involved |
| Diagnosis | Examine for signs of infection (fever, malaise) - Examine for redness, swelling of the nose, fluctuance, tenderness and congestion Level 1: - Examine for nasal septal swelling, fluctuance, tenderness and congestion. A headlight, torch or lamp may be used. Level 2: - Anterior rhinoscopy may be performed to evaluate the nasal septal swelling. |
| Investigations | |
| Management | Management: 1. Incision & drainage- the abscess should be incised & drained under local anesthesia; nasal pack should be used. 2. Systemic broad-spectrum antibiotic like amoxicillin or cephalosporin etc. can be given. General: - Analgesia, antipyretics and antibiotics should be administered. - Fine needle aspiration may be attempted for a localised abscess - Incision and drainage should be performed if the abscess persists after needle aspiration, if there is recurrence or if there is evidence of septal cartilaginous destruction - Computed tomography scanning may be useful in demonstrating cartilaginous destruction - Broad spectrum antibiotic cover should be instituted empirically while awaiting culture and sensitivity results. Level 1: - Fine needle aspiration can be attempted to confirm diagnosis - Analgesia and broad spectrum antibiotics should be administered prior to referral to the next level of facility Level 2: - Incision and drainage should be performed on confirming diagnosis. Incision should be at the dependent part of the abscess. Pus swab collected should be sent for culture and sensitivity. - Analgesia and broad spectrum antibiotics should be administered prior to referral to the next level of facility Level 3: - Incision and drainage should be performed on confirming diagnosis. Incision should be at the dependent part of the abscess. Pus swab collected should be sent for culture and sensitivity. A penrose drain should be applied if cartilaginous loss is present. An anterior nasal pack should be applied to tamponade the mucosa against the septum - Analgesia, antipyretics and antibiotics should be administered - Any necrosed cartilage should be removed via suction. If there is extensive cartilage necrosis, nasal deformity may occur requiring revision in the future. |
| Introduction | Nasal septal abscess is an uncommon condition. It is characterized by the collection of pus between the cartilaginous or bony nasal septum and the overlying mucoperichondrium or mucoperiosteum respectively. They mostly occur as a consequence of a septal haematoma but may also occur spontaneously or secondary to a sinonasal infection or a nasogastric tube. The cartilaginous septum receives its blood supply from the overlying mucous membrane and these vessels pierce the mucoperichondrium |
| History | |
| Etiology | |
| Clinical Features | Clinical features: 1. Throbbing pain & temperature. 2. Nasal obstruction on both sides. 3. Ant. rhinoscopy: Shows symmetrical swelling of the anterior part of the nasal septum & oedema of the nose. |
| Preventions | |
| Treatment | Adquate surgical drainage, and parenteral antibiotics to prevent the potentially dangerous spread of infection and the development of severe functional and cosmetic sequelae see under management |
| Complications | Complications: 1. Perforation of septal cartilage. 2. Falling of lip of the nose. 3. Cellulitis of the nose, meningitis etc. Complications of a nasal septal abscess include septal perforation, facial cellulitis, saddle deformity due to cartilage necrosis, sinusitis, orbital cellulitis, meningitis, brain abscess and cavernous sinus thrombophlebitis |
| Prognosis | |
| Types | |
| Classification | |
| Observation | |
| Pathology | A collection of pus in the space between the cartilaginous or bony nasal septum and its overlying mucoperichondrium or mucoperiosteum |
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