Nasal septal hematoma: Difference between revisions
m (Rossdonaldson1 moved page Septal hematoma to Nasal septal hematoma) |
ClaireLewis (talk | contribs) |
||
| (18 intermediate revisions by 5 users not shown) | |||
| Line 1: | Line 1: | ||
==Background== | ==Background== | ||
*Submucosal vessels disrupted | |||
*Blood accumulates between perichondrium and cartilaginous septum | |||
*Requires immediate incision and drainage to prevent nasal septum necrosis | *Requires immediate incision and drainage to prevent nasal septum necrosis | ||
**Can lead to saddle nose deformity, nasal septum abscess | **Can lead to saddle nose deformity, nasal septum abscess | ||
*Suspect septum abscess in | **May be complicated by necrosis and perforation | ||
*Suspect septum [[abscess]] in patient who presents late after [[facial trauma]] with systemic symptoms | |||
*Ensure thorough examination of both nares - Nasal septum cartilage easily fractures (form bilateral hematomas) | *Ensure thorough examination of both nares - Nasal septum cartilage easily fractures (form bilateral hematomas) | ||
*Adults present with significant facial trauma and nasal fracture | ==Clinical Features== | ||
[[File:PMC5042625 OAMJMS-4-413-g001.png|thumb|Bilateral nasal septal hematoma]] | |||
*Adults present with significant [[facial trauma]] and [[nasal fracture]] | |||
*Dark purple hematoma against septum | |||
*Common symptoms in peds, usually within first 24-72 hrs with even minor nasal trauma, include: | *Common symptoms in peds, usually within first 24-72 hrs with even minor nasal trauma, include: | ||
**Nasal obstruction (95%) | **Nasal obstruction (95%) | ||
**Pain (50%) | **Pain (50%) | ||
**Rhinorrhea (25%) | **[[Rhinorrhea]] (25%) | ||
**Fever (25%) | **[[Fever]] (25%) | ||
==Differential Diagnosis== | |||
{{Maxillofacial trauma DDX}} | |||
==Evaluation== | |||
*Usually clinical | |||
*[[Oxymetazoline]] will not change size of hematoma, as opposed to typical soft tissue edema from trauma | |||
==Management== | ==Management== | ||
#Place lidocaine-soaked cotton pledgets in nose for 5min | NEJM procedure video: https://www.youtube.com/watch?v=wPB5XXfhyP8 | ||
#Place [[lidocaine]]-soaked cotton pledgets in nose for 5min | |||
#Achieve visualization with nasal speculum | #Achieve visualization with nasal speculum | ||
#Make horizontal incision superficially through the mucosa and the perichondrium | #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 | #Evacuate clot with Frazier suction or forceps | ||
#Insert single 1/8in iodoform gauze wick into the incision to avoid premature closure | #Insert single 1/8in iodoform gauze wick into the incision to avoid premature closure | ||
#Perform | #Perform bilateral anterior nasal packing with nasal tampons coated with topical antibiotics | ||
# | #*Prevents reaccumulation of clot and keeps septum midline | ||
#Give oral | #Give oral [[antibiotics]] (cover [[S. aureus]], [[H. flu]], [[S. pneumo]]) | ||
# | #*[[Amoxicillin-clavulanate]] for uncomplicated | ||
# | #**[[Clindamycin]] if [[abscess]] suspected | ||
==Disposition== | ==Disposition== | ||
*Discharge | *Discharge with 24hr ENT or ED follow-up | ||
==See Also== | ==See Also== | ||
Revision as of 21:20, 30 September 2019
Background
- Submucosal vessels disrupted
- Blood accumulates between perichondrium and cartilaginous septum
- Requires immediate incision and drainage to prevent nasal septum necrosis
- Can lead to saddle nose deformity, nasal septum abscess
- May be complicated by necrosis and perforation
- Suspect septum abscess in patient who presents late after facial trauma with systemic symptoms
- Ensure thorough examination of both nares - Nasal septum cartilage easily fractures (form bilateral hematomas)
Clinical Features
- Adults present with significant facial trauma and nasal fracture
- Dark purple hematoma against septum
- 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%)
Differential Diagnosis
Maxillofacial Trauma
- Ears
- Nose
- Oral
- Other face
- Zygomatic arch fracture
- Zygomaticomaxillary (tripod) fracture
- Related
Evaluation
- Usually clinical
- Oxymetazoline will not change size of hematoma, as opposed to typical soft tissue edema from trauma
Management
NEJM procedure video: https://www.youtube.com/watch?v=wPB5XXfhyP8
- 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 bilateral anterior nasal packing with nasal tampons coated with topical antibiotics
- Prevents reaccumulation of clot and keeps septum midline
- Give oral antibiotics (cover S. aureus, H. flu, S. pneumo)
- Amoxicillin-clavulanate for uncomplicated
- Clindamycin if abscess suspected
- Amoxicillin-clavulanate for uncomplicated
Disposition
- Discharge with 24hr ENT or ED follow-up