Nasal septal hematoma: Difference between revisions
Line 23: | Line 23: | ||
##Prevents reaccumulation of clot and keeps septum midline | ##Prevents reaccumulation of clot and keeps septum midline | ||
#Give oral abx (cover S. aureus, H. flu, S. pneumo) | #Give oral abx (cover S. aureus, H. flu, S. pneumo) | ||
## | ##Amoxicillin/clavulanate for uncomplicated | ||
## | ##Clindamycin if abscess suspected | ||
==Disposition== | ==Disposition== |
Revision as of 20:00, 12 August 2014
Background
- Requires immediate incision and drainage to prevent nasal septum necrosis
- Can lead to saddle nose deformity, nasal septum abscess
- Suspect septum abscess in pt who presents late after facial trauma with systemic symptoms
- Ensure thorough examination of both nares - Nasal septum cartilage easily fractures (form bilateral hematomas)
- Adults present with significant facial trauma and nasal fracture
- Common symptoms in peds, usually within first 24-72 hrs with even minor nasal trauma, include:
- Nasal obstruction (95%)
- Pain (50%)
- Rhinorrhea (25%)
- Fever (25%)
Treatment
- Place lidocaine-soaked cotton pledgets in nose for 5min
- Achieve visualization with nasal speculum
- Make horizontal incision superficially through the mucosa and the perichondrium
- Ensure that you do not incise the cartilagenous septum
- Evacuate clot with Frazier suction or forceps
- Insert single 1/8in iodoform gauze wick into the incision to avoid premature closure
- Perform b/l anterior nasal packing w/ nasal tampons coated w/ topical abx
- Prevents reaccumulation of clot and keeps septum midline
- Give oral abx (cover S. aureus, H. flu, S. pneumo)
- Amoxicillin/clavulanate for uncomplicated
- Clindamycin if abscess suspected
Disposition
- Discharge w/ 24hr ENT or ED follow-up
Source
- Tintinalli
- eMedicine