Non-accidental trauma presenting with nasal septal hematoma or abscess

Failure to diagnose non-accidental trauma (NAT) leaves the victim at risk of further injury or even death. It is incumbent upon physicians and other health care personnel to identify trauma patterns that have a high likelihood of being caused by NAT. The objective of this study is to discuss the presentation of nasal septal hematoma (NSH) or nasal septal abscess (NSA) as a sign of NAT.

This is a retrospective case series of patients presenting with nasal septal hematoma or abscess between 2010 and 2019. The primary endpoint was the etiology of the injury. Secondary endpoints included demographics, concomitant injuries and treatments rendered.

There were 28 patients who presented with septal hematoma or abscess. The etiologies included 20 (71.4%) due to accidental trauma, four (13.8%) with NAT, one infectious, and three unknown. All four NAT patients were male and infants with an average age of 5.4 months (SD 4.6) significantly (p = 0.0069) younger than 10.3 years (SD 5.1) in the accidental trauma group. There was a delayed time to presentation for the NAT patients compared to other etiologies. Two of four NAT patients were initially thought to have a congenital midline nasal dermoid, yet surgical intervention revealed a hematoma. Further NAT evaluation noted concomitant injuries including rib fractures and intracranial injuries in 75% of the NAT patients.

Presentation of a child with NSH/NSA prior to the onset of ambulation or with a delayed time to presentation should prompt suspicion and further workup for NAT.