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Nasal Septal Hematoma

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Nasal Septal Hematoma, Septal Hematoma

  • Definition
  1. Blood between septal cartilage and mucoperichondrium
  • Cause
  • Signs
  1. Soft, fluctuant swelling of septum
  2. Bilateral is most common
  • Management
  • General
  1. Urgent referral to otolaryngology
  2. Drainage should be done as soon as possible
    1. Within hours of onset is preferred
  1. Topical and local anesthetic
  2. Incision and Drainage
    1. Using a number 11 blade, make a small longitudinal incision into hematoma
    2. Apply pressure or suction to evacuate the hematoma
    3. Needle Aspiration may be performed as an alternative but risk of reaccumulation
  3. Bilateral Nasal Packing for several days
    1. Packing should contain anti-staphylococcal antibiotic
  4. Start prophylactic antibiotics
  5. Follow-up for recheck with ENT within 72 hours
  • Complications
  1. Infected Septal Hematoma
  2. Saddle nose deformity
    1. Results from infection and septal cartilage necrosis
  • References
  1. Wu in Majoewsky (2012) EM:Rap 12(11): 10
  2. Kucik (2004) Am Fam Physician 70(7):1315-20 [PubMed]