Treatment of Septal Hematomas and Abscesses in Children

ABSTRACT

The cartilaginous part of the nasal septum of a child with a septal hematoma or abscess is at risk of destruction. Consequently, the noses of these children can collapse, causing a saddle nose deformity, and in time, the normal outgrowth of both the nose and maxilla will be disturbed. In adulthood, they will have an underdeveloped saddle nose deformity with too much upward rotation of the nasal tip and a retroposition of the midface. Sequelae like these should be prevented by prompt diagnosis and surgical intervention. In this article, the management of septal hematomas and abscesses is discussed with special focus on reconstruction of destructed septal cartilage with the use of autologous cartilage grafts fixed to a polydioxanon plate.

KEYWORDS

Child - nasal septum - hematoma - abscess - saddle nose - reconstruction - PDS plate

REFERENCES

• 1 Olsen K D, Carpenter III R J, Kern E B. Nasal septal injury in children.  Arch Otolaryngol. 1980;  106 317-320
• 2 Close D M, Guinnes M DG. Abscess of the nasal septum after trauma.  Med J Aust. 1985;  142 472-474
• 3 Canty P A, Berkowitz R J. Hematoma and abscess of the nasal septum in children.  Arch Otolaryngol Head Neck Surg. 1996;  122 1373-1376
• 4 Ambrus P S, Eavey R D, Baker A S et al.. Management of nasal septal abscess.  Laryngoscope. 1981;  91 575-582
• 5 Huizing E H. Long term results of reconstruction of the septum in the acute phase of a septal abscess in children.  Rhinology. 1984;  22 55-63
• 6 Grymer L F, Bosch C. The nasal septum and the development of the midface. A longitudinal study of a pair of monozygotic twins.  Rhinology. 1997;  35 6-10
• 7 Nolst Trenité G J, Verwoerd C D, Verwoerd-Verhoef H L. Reimplantation of autologous septal cartilage in the growing nasal septum. I. The influence of resection and reimplantation of septal cartilage upon nasal growth: an experimental study in rabbits.  Rhinology. 1987;  25 225-236
• 8 Verwoerd C D, Urbanus N A, Nijdam D C. The effects of septal surgery on the growth of nose and maxilla.  Rhinology. 1979;  17 53-63
• 9 Verwoerd C DA, Verwoerd-Verhoef H L. Rhinosurgery in children. Developmental and surgical aspects. In: Nolst Trenite GJ Rhinoplasty, A Practical Guide to Functional and Aesthetic Surgery of the Nose (Chapter 20), 3rd ed. Amsterdam, The Netherlands; Kugler Publications 2005
• 10 Boenisch M, Mink A. Clinical and histological results of septoplasty with a resorbable implant.  Arch Otolaryngol Head Neck Surg. 2000;  126 1373-1377
• 11 Boenisch M, Tamas H, Nolst Trenité G J. Influence of polydioxanone foil on growing septal cartilage after surgery in an animal model (preliminary results).  Arch Facial Plast Surg. 2003;  5 316-319
• 12 Boenisch M, Nolst Trenité G J. New concepts in reconstructive septoplasty. In: Nolst Trenite GJ Rhinoplasty, A Practical Guide to Functional and Aesthetic Surgery of the Nose, 3rd ed. Amsterdam, the Netherlands; Kugler Publishers 2005: 285-295
• 13 Hollinger J O, Battistone G. Biodegradable bone repair materials.  Clin Orthop Relat Res. 1986;  207 290-305