II. Definitions
- Septal Hematoma
- Blood between septal cartilage and mucoperichondrium
III. Causes
-
Nasal Trauma including Nasal Fracture
- Septal Hematoma may result from even mild Trauma in Children (consider Nonaccidental Trauma)
IV. Signs
- Soft, fluctuant swelling of septum
- Bilateral is most common
V. Management: General
- Urgent referral to otolaryngology
- Drainage should be done as soon as possible
- Within hours of onset is preferred
VI. Management: Incision and Drainage
-
Informed Consent
- Risk of hematoma reaccumulation
- Risk of ongoing bleeding
- Caution in Anticoagulant use or Coagulopathy
- Topical and local Anesthetic
-
Incision and Drainage
- Using a number 11 blade, make a small, 5-10 mm longitudinal incision into hematoma
- Apply pressure or suction to evacuate the hematoma of clots (some experts irrigate cavity)
- Needle Aspiration may be performed as an alternative but risk of reaccumulation
- Bilateral Nasal Packing for no more than 48 to 72 hours
- Some recommend that packing should contain anti-staphylococcal antibiotic (controversial)
- Consider prophylactic antibiotics
- Follow-up for recheck with ENT within 72 hours
VII. Complications
- Infected Septal Hematoma
- Nasal septal perforation
- Nasal obstruction
- Saddle nose deformity
- Results from infection and septal cartilage necrosis
VIII. References
- Warrington (2021) Crit Dec Emerg Med 35(2): 11
- Wu in Herbert (2012) EM:Rap 12(11): 10
- Kucik (2004) Am Fam Physician 70(7):1315-20 [PubMed]
Images: Related links to external sites (from Bing)
Related Studies
| Concepts | Disease or Syndrome (T047) |
| SnomedCT | 232377002 |
| English | nasal septal hematoma, hematoma septal nasal, Nasal septal haematoma, Nasal septal hematoma, Nasal septal hematoma (disorder) |
| Spanish | hematoma del tabique nasal (trastorno), hematoma del tabique nasal |
