Nasal Septal Abscess in Children

Abstract

Setting: University hospital. Patients: Six patients (5 boys and 1 girl), aged 3 to 11 years, with nasal septal abscess. Intervention: The nasal septa of 6 children with a history of nasal septal abscess and partial or complete destruction of nasal septal cartilage were reconstructed with autologous cartilage grafts of the auricle or rib fixed on polydioxanone plate. Main Outcome Measures: Nasal outgrowth was measured by the length of the nose and by the amount of nasal tip projection and was compared with standardized growth curves. Aesthetic outcome variables included nasolabial angle, columellar retraction, and development of saddle nose deformity and were classified as normal, mild, or severe. Results: The duration of follow-up ranged from 10 to 68 months (mean follow-up, 38 months). Four children had complete loss of the cartilaginous septum. Areas 1 and 2 (caudal parts) had been destroyed in 2 children. Auricular cartilage was used in 5 children; costal cartilage was needed in 1 child. Compared with standardized growth curves, the length of the nose and the amount of nasal tip projection were within 1 SD in all children. None of the children developed saddle nose deformity. One child had mild columellar retraction; 3 children had mild overrotation of the nasal tip. Conclusion: Total reconstruction of abscess-induced destruction of nasal septal cartilage with autologous cartilage grafts fixed on polydioxanone plate has, so far, resulted in normal development of the nose during followup, without expected aesthetic problems.

Spontaneous Nasal Septal Abscess Presenting as Complete Nasal Obstruction

“…Together with the digestive process of leukocytes and Cathepsin D, an enzyme responsible for reshaping the quadrangular cartilage, this may result in septal cartilage destruction, saddle nose deformity and lead to both functional and cosmetic problems [9]. In a growing child in particular, there may be additional disturbance of the normal development of the nose and maxilla [9,10]. Delayed diagnosis and management may also lead to life-threatening intracranial infective com-plications such as brain abscess, meningitis and cavernous sinus thrombosis, especially in immunocompromised patients [2][3][4][5][6][7][8].…”

“…It may be carried out immediately after drainage of the abscess as a primary treatment, or secondary treatment after resolution of the infection [6,9]. Reconstruction of the destroyed septal infrastructure may be made use of residual septal cartilage by mosaicplasty or exchange technique; or autologous cartilage grafts from tragus, auricle or rib [9,10].…”

Rhinosurgery in children: developmental and surgical aspects of the growing nose

“…Recently it was suggested to restore the septum with a single large cartilaginous implant. Autologous grafts of ear cartilage were affixed to a polydioxanone (PDS) foil, to ensure good tissue-to-tissue approximation of the individual grafts [ 163 ].…”

Comment on: Nasal Septal Perforation Reconstruction with Polydioxanone Plate: A Systematic Review

“…However, we would like to respectfully draw attention to one of the included studies, which may not directly pertain to septal perforation repair. The cited paper by Menger et al 1 describes nasal septal reconstruction following abscess formation in children, using autologous cartilage grafts mounted on a PDS plate. This study focused on septal integrity restoration after abscess-related cartilage loss rather than closure of a preexisting septal perforation.…”