Hematoma and abscess of the nasal septum in children

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 β-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.