Hematoma and abscess of the nasal septum in children

Arch Otolaryngol Head Neck Surg. 1996 Dec;122(12):1373-6. doi: 10.1001/archotol.1996.01890240079017.


Objective: To evaluate the clinical characteristics and treatment outcome of hematoma and abscess of the nasal septum (HANS) in children.

Design: Retrospective case series.

Setting: Pediatric tertiary care facility.

Patients: Consecutive series of 20 children (age, 2 months to 15 years; mean age, 7 years) who were admitted to the hospital for treatment of HANS after nasal trauma during an 18-year period.

Interventions: In addition to receiving antibiotics, all patients underwent general anesthetic for incision and evacuation of the collection of blood and pus together with nasal packing.

Results: All patients had a history of nasal trauma. The HANS was a consequence of child abuse (2 patients younger than 2 years), minor nasal trauma (14 patients aged 1 to 10 years), and sports injury (4 patients older than 10 years). The diagnosis was made 1 to 14 days (mean, 5.9 days) after the episode of trauma. Nasal obstruction was the most common symptom found and was present in all but 1 patient. Pain, rhinorrhea, and fever occurred in 50%, 35%, and 25% of patients, respectively. Nasal fracture was present in 3 children. Abscess was found at surgery in 12 patients and was universally associated with septal cartilage destruction. Hematoma was present in 8 patients and associated with cartilage destruction in 2 patients. Organisms cultured were Staphylococcus aureus, Streptococcus pneumoniae, and group A beta-hemolytic streptococcus and were obtained from all 12 patients with septal abscess and from 1 patient with septal hematoma. Corrective nasal surgery has been performed in 5 patients, 4 of whom had a history of septal abscess.

Conclusion: The diagnosis of HANS must be considered in all children who have acute onset of nasal obstruction and a history of recent nasal trauma to minimize the risk of nasal deformity and prevent the development of septic complications.

MeSH terms

  • Abscess / microbiology
  • Abscess / surgery*
  • Adolescent
  • Cartilage Diseases / etiology
  • Cartilage Diseases / microbiology
  • Cartilage Diseases / surgery*
  • Child
  • Child, Preschool
  • Drainage
  • Female
  • Hematoma / etiology
  • Hematoma / microbiology
  • Hematoma / surgery*
  • Humans
  • Infant
  • Male
  • Nasal Septum*
  • Nose / injuries*
  • Retrospective Studies