Alabi, Biodun S.

Aremu, Shuaib K.

Omokanye, Habib O.

Afe Babalola University Repository

∙ My Account∙ Logout∙ e-News Sign-up∙ Subscribe∙ Advertise∙ Otology∙ Rhinologyooooooo∙ Laryngology∙ Head and Neck∙ Other ENT Topics∙ For Authors∙ Resources∙ Contact UsDentogenic nasal septal abscessMarch 1, 2011 by Shuaib K. Aremu, FWACS, Biodun S. Alabi, FWACS, and Habib O.Omokanye, MBBSShare on facebook Share on linkedin Share on twitter Share on google More SharingServices | ReprintsRhinoscopic ClinicFigure. The bilateral masses (A) and nasal swelling (B)are evident at presentation.Nasal septal abscess (NSA) is de&filig;ned as a collection of pus between thecartilaginous or bony septum and the mucoperichondrium or periosteum.1 As theinfection progresses, a collection of &fllig;uid (pus or blood) separates themucoperichondrial blood supply from the underlying septal cartilage. The resultantischemia and pressure, as well as microbial in&fllig;uences, can cause necrosis ofthe septal cartilage in 24 to 48 hours. The destruction of cartilage can cause septaldeformity, perforation, or saddle-nose deformity, which can lead to severe functionaland cosmetic sequelae.NSA of dentogenic origin is extremely rare, as only 3 cases have been previouslyreported in the English-language literature.2,3 We report a new case.A 41-year-old man presented to our ENT department with complaints of aforeign-body sensation in his nose, nasal airway obstruction, a swollen upper lip, andassociated pain. He had no history of sinusitis or relevant trauma. Approximately 10days prior to presentation, he had undergone a root canal in the upper left secondincisor. His symptoms manifested a few days later.Physical examination revealed the presence of a round, purplish, anterior mass inthe nose that splayed bilaterally from the nasal septum (figure, A). The upper lip andperinasal area were swollen and tender to palpation (figure, B). X-ray detected alarge periapical lesion associated with the upper left second incisor.The patient was administered topical anesthesia, and aspiration of the mass wasperformed. The aspiration yielded a scant amount of pus, although it was sufficientfor microbiologic evaluation. In the meantime, the patient was started onamoxicillin/clavulanic acid at 625 mg twice daily and metronidazole at 500 mg threetimes daily. Apical resection was planned pending resolution of the acutesymptoms, which occurred 3 days after the commencement of the antibioticregimen.Intraoperatively, the apical lesion we encountered was larger than it appeared to beon radiography. The lesion extended to the floor of the nasal cavity, where weencountered a grayish nasal mucosa. Granulation tissue was curetted, and the roottip was excised. About 3 ml of pus was drained from the area.Postoperatively, the patient was continued on his medication regimen for 1 week. Atthe time of suture removal, his nasal airway obstruction and upper lip swelling hadcompletely resolved. At the 1-month follow-up, no evidence of infection was noticed.The potentially life-threatening complications of the contiguous spread of infectionfrom an NSA include orbital or intracranial abscesses, meningitis, and cavernoussinus thrombosis.3 Piotrowski et al reported a case of nasal septum abscess thatwas complicated by cavernous sinus thrombophlebitis in a 4-year-old boy.4 Thedanger of complications from NSA is heightened in patients with compromised hostdefenses. In the immunocompromised population, NSA can develop withoutantecedent injury, and it may involve atypical pathogens.Most often, the choice of antibiotic is penicillin. Evaluation of aspiration samplesusually reveals staphylococci.5 The treatment protocol generally depends on thesource of the infection. In our case, antibiotic treatment and the removal of thesource of infection were sufficient.From the Department of Otorhinolaryngology, University of Ilorin Teaching Hospital,Ilorin, Kwara State, Nigeria.References1. Ambrus PS, Eavey RD, Baker AS, et al. Management of nasal septal abscess.Laryngoscope 1981; 91 (4): 575-82.2. Chopra SS, Desai NT. Nasal septal abscess due to infection from upperincisors. J Indian Dent Assoc 1969; 41 (9): 249-50.3. da Silva M, Helman J, Eliachar I, Joachims HZ. Nasal septal abscess of dentalorigin. Arch Otolaryngol 1982; 108 (6): 380-1.4. Santiago R, Villalonga P, Maggioni A. Nasal septal abscess: A case report.International Pediatrics 1999; 14 (4): 229-31.5. Piotrowski S, Augustyniak M, Bojarska D, Mielniczak K. Cavernous sinusthrombosis-complication of nasal septum abscess in a child &lsqb;inPolish&rsqb;. Wiad Lek 1994; 47 (3-4): 155-7.6. Dixon DM, McNeil MM, Cohen ML, et al. Fungal infections: A growing threat.Public Health Rep 1996; 111 (3): 226-35.Ear Nose Throat J. 2011 March;90(3):E27

Dentogenic nasal septal abscess

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Dentogenic nasal septal abscess

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