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Reprint Address: Hsin-Chien Chen, md, phd, Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, 325, Sec. 2, Cheng-Kung Rd, Taipei 114, Taiwan
Affiliations
Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
A 58-year-old man was referred to our hospital with a 2-week history of nasal obstruction,
pain, and intermittent fever. He had visited two other hospitals, where oral antibiotics
and local treatment of the nose had been given. He had no recent history of nasal
trauma, surgery, sinusitis, or dental infections. Physical examination revealed bulging
septal mucosa occupied his bilateral nasal cavity (Figure 1A and 1B). Maxillofacial computed tomography with contrast showed a hypodense lesion
with ring enhancement measuring approximately 2.9 × 2.4 cm at the anterior septum
(Figure 1D–1F). An emergent incision and drainage was performed under general anesthesia. Approximately
6 mL pus was drained via an incision placed just about 5 mm above the caudal border
of the septal cartilage, known as Killian's incision (Video 1). Operative findings showed absence of cartilaginous septum. A septal mucosa suture
with Penrose drain was placed. A bacterial culture of the purulent fluid grew Viridans streptococcus. The nasal septum recovered with visible bilateral inferior turbinate and nasal cavity
(Figure 1C). Unfortunately, the patient finally complicated with a depressed nasal tip.
Figure 1(A and B) Congested and bulging septal mucosa occluded bilateral nasal cavity (arrows).
(C) Swollen nasal septum was resolved and bilateral inferior turbinate (arrows) and
nasal cavity was visible following operation. (D–F) Maxillofacial computed tomography
with contrast showed a hypodense lesion with ring enhancement about a size of 2.9 × 2.4 cm
at anterior septum (arrows).
