Abscess and hematoma of the septum – old diagnosis, contemporary treatment options

Introduction. Hematoma of the nasal septum is accumulation of the blood or pus in a space between septum and its overlying mucoperichondrium or mucoperiosteum layer. If left untreated, may lead to nose and facial deformity, and delayed facial growth and even to intracranial complications. Aim of the study is to present and compare different techniques of treatment. We present our guidelines how to treat the condition. Material and methods. Cases of 20 patients with septal hematoma or abscess hospitalized at the Pediatric Laryngology Clinic between January 1, 2015 and January 1, 2021 were analyzed. Results. Patients were between 8 months and 18 years of age. Nine present septal abscesses and eleven hematomas. All cases of abscess coexisted with destruction of the septal cartilage as well as one case of recurrent septal hematoma. The most common pathogen was S.aureus, in one case MRSA and that patient neded re-drainage of the abscess. All patients had an abscess/hematoma drained under general anesthesia. Some had septum reconstructed with homologous donor cartilage implants, autologous reconstruction with the auricle cartilage, or complex homologous donor cartilage implant reconstruction. Conclusion. Treatment is surgical drainage of the hematoma/abscess and inserting suction of teflon strip and anterior nasal package. Crucial is quite early reconstruction of the septum when already damaged by the abscess.