The child was admitted and started on intravenous Amoxycillin Clavulanic acid, metronidazole and amikacin. The total leukocyte count at admission were 18000 with predominance of neutrophils and platelets.
Wide bore needle aspiration done under GA as shown in figure which aspirated 5 cc thick non foul smelling pus. The pus was sent for Culture. Then left freer incision was given and betadine irrigation done in the septal space. Cartilage was found to be absorbed already. Bilateral merocel pack given. Freer incision left as such. A small 1 mm window created in mid flap for further drainage of abscess.
The fever subsided next day and dorsal nasal swelling also subsided. The culture grew cocci in clusters sensitive to Augmentin, Amikacin, clarithromycin etc.
The child was discharged next day. In followup child is doing good though septum is slightly thick but that will become normal after few days in healing. Parents have been counselled regarding chance of saddling of nose as he grows further.
I invite any question or suggestion in the comment section. Dr. Ajay Jain