Nasal Septal Hematoma

Aka: Nasal Septal Hematoma, Septal Hematoma, Nasal Septal Hematoma Drainage, Septal Hematoma Evacuation

advertisement

II. Definitions

  1. Septal Hematoma
    1. Blood between septal cartilage and mucoperichondrium

III. Causes

  1. Nasal Trauma including Nasal Fracture
    1. Septal Hematoma may result from even mild Trauma in Children (consider Nonaccidental Trauma)

IV. Signs

  1. Soft, fluctuant swelling of septum
  2. Bilateral is most common

V. Management: General

  1. Urgent referral to otolaryngology
  2. Drainage should be done as soon as possible
    1. Within hours of onset is preferred

VI. Management: Incision and Drainage

  1. Informed Consent
    1. Risk of Hematoma reaccumulation
    2. Risk of ongoing bleeding
      1. Caution in Anticoagulant use or Coagulopathy
  2. Topical and Local Anesthetic
    1. Lidocaine 2-4% via MADD Atomizer
    2. Consider Lidocaine 1% injected into mucosal wall of Septal Hematoma
  3. Incision and Drainage
    1. Using a number 11 blade, make a small, 5-10 mm longitudinal incision into Hematoma
    2. Apply pressure or suction to evacuate the Hematoma of clots (some experts irrigate cavity)
    3. Needle Aspiration may be performed as an alternative but risk of reaccumulation
  4. Bilateral Nasal Packing for no more than 48 to 72 hours
    1. Some recommend that packing should contain anti-staphylococcal antibiotic (controversial)
  5. Consider prophylactic antibiotics
  6. Follow-up for recheck with ENT within 72 hours

VII. Complications

  1. Infected Septal Hematoma
  2. Nasal septal perforation
  3. Nasal obstruction
  4. Saddle nose deformity
    1. Results from infection and septal cartilage necrosis

VIII. References

  1. Warrington (2021) Crit Dec Emerg Med 35(2): 11
  2. Wu in Herbert (2012) EM:Rap 12(11): 10
  3. Kucik (2004) Am Fam Physician 70(7):1315-20 [PubMed]

Images: Related links to external sites (from Bing)

These images are a random sampling from a Bing search on the term "Nasal Septal Hematoma." Click on the image (or right click) to open the source website in a new browser window. Search Bing for all related images

Related Studies

Related Topics in Nasal Disease

advertisement