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Nasal Septal Hematoma
Aka: Nasal Septal Hematoma, Septal Hematoma, Nasal Septal Hematoma Drainage, Septal Hematoma Evacuation
- Definitions
- Septal Hematoma
- Blood between septal cartilage and mucoperichondrium
- Causes
- Nasal Trauma including Nasal Fracture
- Septal Hematoma may result from even mild Trauma in Children (consider Nonaccidental Trauma)
- Signs
- Soft, fluctuant swelling of septum
- Bilateral is most common
- Management: General
- Urgent referral to otolaryngology
- Drainage should be done as soon as possible
- Within hours of onset is preferred
- Management: Incision and Drainage
- Informed Consent
- Risk of hematoma reaccumulation
- Risk of ongoing bleeding
- Caution in Anticoagulant use or Coagulopathy
- Topical and local Anesthetic
- Lidocaine 2-4% via MADD Atomizer
- Consider Lidocaine 1% injected into mucosal wall of Septal Hematoma
- 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
- Complications
- Infected Septal Hematoma
- Nasal septal perforation
- Nasal obstruction
- Saddle nose deformity
- Results from infection and septal cartilage necrosis
- 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]