Danger triangle of face

Q: 72-year-old patient who is intubated for a week due to severe ARDS after community-acquired pneumonia, noted to have an abscess of 2 x 3 cm at the nasal fold. The abscess appears slightly deep but is hard to ascertain. On slight palpation, it appears fluid-filled. Your next action?

A) Do needle aspiration

B) Do incision and drainage

C) Consult ENT

D) Observe

Answer: C

This question emphasizes the importance of infections and abscesses in the central triangle of the face (corners of the mouth and the nasal bridge). This area is popularly known as the "Danger Triangle of the Face" as it carries a high risk of septic phlebitis and intracranial extension through the cavernous sinus. 

Radiological workup to assess depth and evaluation by an ENT service are recommended instead of blind bedside incision and drainage. Usually, superficial abscesses can be managed with warm compresses and broad-spectrum antibiotics. However, early investigation is warranted to avoid major complications.

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References:

1. Pannu AK, Saroch A, Sharma N. Danger Triangle of Face and Septic Cavernous Sinus Thrombosis. J Emerg Med. 2017 Jul;53(1):137-138. doi: 10.1016/j.jemermed.2017.03.016. Epub 2017 Apr 10. PMID: 28408235.

2. Battistin U, Hallak YO, Hallak F, Hallak O, AlKhani R. Subacute Cavernous Sinus Thrombosis following a Dental Procedure: Case Report and Review of the Literature. Clin Neurol Neurosurg. 2020 Oct;197:106135. doi: 10.1016/j.clineuro.2020.106135. Epub 2020 Aug 16. PMID: 32836064.

3. Thong JK, Ho BJW, Lim EH, Singh S. A Rare Case of an Isolated Nasal Floor Abscess in an Immunocompetent Patient. Cureus. 2025 Nov 24;17(11):e97694. doi: 10.7759/cureus.97694. PMID: 41450431; PMCID: PMC12737980.