Novel local antimicrobial treatment with vancomycin-calcium sulfate following surgical treatment of a postoperative septal abscess

Introduction:
Nasal septal abscess (NSA) is a rhinologic emergency that typically results from
infection in the space between the nasal septum and the overlying
mucoperichondrium or mucoperiosteum, often secondary to nasal septal hematoma.
Early diagnosis and intervention are crucial to prevent complications such as septal
perforation or saddle nose deformity. In this context, additional antibiotic therapy is
essential.
Case/Methods:
A 49-year-old woman presented with painful, progressive swelling and redness at
the columella, five weeks after undergoing functional rib graft septorhinoplasty with septal
extension, strut graft, rim grafts, and diced cartilage. Extensive endonasal drainage
of the abscess was performed, followed by the placement of resorbable calcium
sulfate flakes impregnated with vancomycin. Intravenous clindamycin was continued
for one week.
Results:
Oral clindamycin was discontinued after one week with no evidence of local irritation
and normal inflammatory markers. Two weeks postoperatively, the septum showed
no signs of inflammation or swelling. Serum calcium levels remained within the upper
normal range throughout follow-up.
Discussion:
This report presents the first use of calcium sulfate as a carrier for local antibiotic
therapy in the treatment of septal abscess. The resorbable matrix may offer an
effective treatment for infections related to rhinoplasty complications and could serve
as a potent preventive antimicrobial agent in patients undergoing septorhinoplasty.

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