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Nasal Septal Abscess: causes, symptoms, ddx, complications, treatment

Definition: Pus collection between mucoperichondrium & cartilage of the nasal septum. It is uncommon medical condition but serious.

Etiology (causes)

Symptoms: 

  • Fever, headache, and malaise.
  • Throbbing pain.
  • Bilateral Nasal obstruction.
  • Purulent discharge, if ruptured.


Signs: 

  • Bilateral fluctuant, tender swelling on both sides of septum.
  • Tenderness and edema of nasal tip.

Differential Diagnosis (DDx):

  • Neoplastic: Lymphoma, metastasis, nasal glioma, esthesioneuroblastoma, sarcoma, chloroma.
  • Infectious: Typical infections (S. aureus, S. pneumonia), atypical (tuberculosis, fungal).
  • Inflammatory: Wegener granulomatosis.

Complications:


Treatment: 

  • Aspiration, if the patient visits the doctor early.
  • As newborn babies are obligatory nose breathers, they may need additional care including the placement of a tube to help them breathe while the hematoma heals.
  • Incision & evacuation: Drainage under local anathesia usually, but some cases (particularly babies and very young children) may need general anesthesia.Transverse incision, to avoid disturbance of mucociliary transport. Put a nasal pack for 24hours.
  • Broad spectrum antibiotics.

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