Septal abscess in a 14-month-old child: Diagnosis, management, and discussion of reconstructive options

Objectives: Highlight the importance of early diagnosis and treatment of septonasal abscesses to prevent life threatening consequences. Explain the aesthetic implications as well as the complications affecting nasal function in toddlers and preschool age children. Suggest reconstructive options and approaches to the pediatric nasoseptum after the deleterious effects of acute inflammation. Methods: Case presentation from a tertiary referral center. Literature review of contemporary and historic treatment of pediatric nasoseptal abscesses. Results: An open approach to nasal reconstruction is recommended with exposure of the caudal septum leaving the dorsal cartilage untouched in order to reduce the risk of nasal and/or midface growth retardation. Costal cartilage is the material of choice to reconstruct the nose because of its proportional growth with the native tissue. Conclusions: The foremost consideration in treatment of nasoseptal hematoma or abscess includes acute drainage and culture-directed antimicrobial medical management to avoid systemic complications. Affected children may require nasal reconstruction, preferably after the 4th year of life. Conscientious surgeons must have an awareness of nasal function, nasofacial development, potential graft donor sites, and subsequent psychological impact of delayed treatment. Our preference is the open approach with the use of autologous costal cartilage for structural reconstruction.