Nasal Septal Hematoma and Abscess in Children I brahim SayN n, MD, Zahide Mine YazN cN , MD, Eyu ¨p Bozkurt, MD, Fatma Tu ¨lin Kayhan, MD Objective: The objective of the study was to evaluate the demographic factors, trauma type, treatment, and long-term results in patients with nasal septal hematoma (NSH) and nasal septal abscess (NSA). Methods: Between the years 2006 and 2010, subjects who received a diagnosis of NSA and NSH were included for the study. Demo- graphic data, the surgical findings, and long term follow-up results were recorded. Results: Twenty-nine subjects were identified. Eleven subjects had a diagnosis of NSA, whereas 19 subjects were identified as having NSH. Eighteen subjects (62.1%) were male, whereas the remain- ing 11 subjects (38.9%) were female. Mean age of the subjects was 7.79 T 3.99 years. The etiologies were fall in 26 subjects (89.6%) and blow in 3 subjects (10.4%). Four subjects were previously ex- amined by a physician. In 9 subjects (31.1%), radiologic and clini- cal evidence of nasal fracture exists. Eighteen (72%) of 29 subjects experienced sequelae. No significant difference exists for clinical properties, demographic data, etiology, and so on, except mean du- ration; P 9 0.05. Mean duration was significantly high in the NSA group than in the NSH group (8.40 T 8.46 days vs 3.58 T 3.64 days, P = 0.025). Conclusions: This study demonstrated that both NSH and NSA have similar properties for demographic data, etiology, and sequelae. Key Words: Nasal trauma, septal hematoma, septal abscess, sequelae N asal trauma in childhood is a common entity. However, devel- opment of nasal septal hematoma (NSH) and nasal septal ab- scess (NSA) after a trauma is relatively rare. The incidence of NSH and NSA is reported to be between 0.8% to 1.6% of the nasal trauma cases. 1 These are also one of the rare emergency situations in the field of rhinology that needed early intervention and close follow- up. Although nasal trauma is a common entity, NSH/NSA was sel- dom reported in the literature especially in pediatric population. 2 This study presented and discussed the clinical properties of subjects with NSH and NSA in the light of current literature. MATERIALS AND METHODS Pediatric subjects who had a diagnosis of and were treated for sep- tal hematoma and abscess were enrolled to the study. This study was undertaken between January 2006 and January 2010. Subjects who completed at least 1-year follow-up were included in this study. All children were treated under general anesthesia. A hemi- transfixion incision was made, and the hematoma and abscess were drained. Appropriate abscess material was obtained for culture. The septal cavity was irrigated with isotonic saline solution. After drain- age, the septum was inspected and palpated with a Cottle elevator to detect the defect areas. If cartilage continuity remained, no ad- ditional procedure was done. If cartilage necrosis was present, the necrotic parts were removed, and residual cartilage parts were re- implanted into the nasal septum, and mosaicplasty was done. No fibrin glue was used to stabilize the pieces of the septal cartilage. Then a penrose drain was used in the septal cavity, and mucoperi- chondiyal layers were approximated to the nasal septum with ab- sorbable suture. A tight nasal packing was also done. During the hospital stay, all cases were treated with systemic antibiotics. (ampicillin-sulbactam for NSH and ceftriaxone for NSA). The nasal packages were removed 2 or 3 days after the surgery. According to drainage findings (hematoma or abscess), subjects were divided into either NSH or NSA group. Patients were revisited, and all subjects were classified accord- ing to the degree of sequelae after the NSA or NSH, similar to that of Alvarez et al. 1 These classification was as follows:  without sequelae.  minor sequelae: minor esthetic deformities, minimal septal, and vault alterations that did not cause airway compromise.  major sequelae: nasal dorsum, tip, or pyramid deformation result- ing to important aesthetic problems, deviation of the septum caus- ing airway compromise, functional vault deformity, and septal perforation. Statistical analyses were performed using the Number Cruncher Statistical System 2007 and Power Analysis and Sample Size 2008 statistical software (NCSS, Kaysville, UT). During the evaluation of the study data, along with the descriptive statistical methods, W 2 and Fisher exact tests were used to compare the parameters between the NSH and NSA groups. The confidence interval was 95%, and P G 0.05 was considered to indicate statistical significance. RESULTS Thirty-eight subjects were identified. Nine subjects were excluded because control examinations could not be done. In total, 29 sub- jects’ results were presented. Nineteen (65.5%) of 29 subjects had a diagnosis of NSH, and the remaining 10 subjects (34.5%) subjects had a diagnosis of NSA. Clinical features are summarized in Table 1. No statistical difference was found between the groups for the men- tioned features (P 9 0.05). Eighteen subjects (62.1%) were male, whereas the remaining 11 subjects (38.9%) were female. Mean age of the subjects was 7.79 T 3.99 years. No significant difference exists for sex and age between groups. Mean duration was significantly high in the NSA group than in the NSH group (8.40 T 8.46 days vs 3.58 T 3.64 days, P = 0.025). The etiologies were fall in 26 subjects (89.6%) and blow in 3 subjects (10.4%). Four subjects were previously examined by a physician. In 9 subjects (31.1%), radiologic and clinical evidence of nasal fracture exists. Nasal fracture was seen high in the NSH group, but significant difference was found for etiology, previous nasal examination, and associated nasal fracture between groups (Table 2, P 9 0.05). The results of the cultures were not satisfactory; only 1 culture was positive for Staphylococcus aureus in the NSA group. Mean follow-up period of the subjects was 30.1 months (range, 12Y58 months). Eighteen (72%) of 29 subjects experienced sequelae. From the E.N.T Clinic., BakNrko ¨y Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey. Received May 4, 2011. Accepted for publication July 12, 2011. Address correspondence and reprint requests to Ibrahim SayNn, MD, BakNrko ¨y Dr. Sadi Konuk Education and Research Hospital, ENT Clinic. Tevfik sa?lam Caddesi, No. 11. 34147, BakNrko ¨y, Istanbul, Turkey; E-mail: dribrahimsayin@yahoo.com The authors report no conflicts of interest. Copyright * 2011 by Mutaz B. Habal, MD ISSN: 1049-2275 DOI: 10.1097/SCS.0b013e31822ec801 The Journal of Craniofacial Surgery & Volume 22, Number 6, November 2011 Brief Clinical Studies * 2011 Mutaz B. Habal, MD e17 Copyright © 2011 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.