Nasal Septal Abscess Diagnosis and Management

Nasal septal abscess is an accumulation of pus between the nasal septum and its overlying mucoperichondrium or mucoperiosteum. Although uncommon in the antibiotic era, it remains a rhinological emergency because delayed recognition can lead to septal cartilage necrosis, saddle-nose deformity, and potentially life-threatening intracranial complications. The condition may arise following trauma, septal haematoma, sinonasal surgery or, less commonly, as a spontaneous infection. Clinically, patients present with progressive nasal obstruction, septal swelling, pain, fever and occasionally rhinorrhoea. Bedside anterior rhinoscopy typically reveals a fluctuant, tender swelling of the septum. Cross-sectional imaging—particularly computed tomography—confirms the extent of fluid collection and excludes intracranial or orbital spread. Management hinges on prompt surgical drainage under local or general anaesthesia, with placement of drains or splints to prevent re-accumulation. Broad-spectrum empirical antibiotics are initiated and then tailored to culture results, with antifungal therapy reserved for immunocompromised hosts or atypical presentations. In children, early septal reconstruction with autologous cartilage grafts may be required to preserve nasal growth. Multidisciplinary care and vigilance for complications underpin optimal outcomes.

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Nasal Septal Abscess Diagnosis and Management publication trend

The graph below shows the total number of articles in nasal septal abscess diagnosis and management across all publications each year (not limited to Nature Index journals).

Technical terms

Nasal septal abscess: A purulent collection between the nasal septum and the overlying mucoperichondrium or mucoperiosteum, often following septal haematoma or trauma.

Septal haematoma: A blood collection beneath the septal mucosa that may compromise cartilage viability if not drained.

Mucoperichondrium/mucoperiosteum: The soft tissue layers that nourish septal cartilage and bone, respectively.

Computed tomography (CT): A cross-sectional imaging technique crucial for delineating abscess extent and detecting complications.

Incision and drainage: A surgical procedure to evacuate pus, relieve pressure and prevent cartilage necrosis.

References

1. Fungal Abscess of Anterior Nasal Septum Complicating Maxillary Sinus Fungal Ball Rhinosinusitis Caused by Aspergillus flavus: Case Report and Review of Literature. Journal of Fungi (2024).
2. Unmasking Nasal Septal Hematoma/Abscess: A Systematic Review and Meta‐analysis. OTO Open (2024).
3. Orbital apex syndrome secondary to a fungal nasal septal abscess caused by Scedosporium apiospermum in a patient with uncontrolled diabetes: a case report. BMC Infectious Diseases (2017).
4. Fungal nasal septum abscess caused by Aspergillus flavus complicating sinonasal surgery. Pan African Medical Journal (2020).
5. Spontaneous Nasal Septal Abscess: A Case Report. Cureus (2024).
6. Spontaneous Nasal Septal Abscess Presenting as Complete Nasal Obstruction. International Journal of Otolaryngology and Head &amp Neck Surgery (2013).