Difference between revisions of "Nasal septal hematoma"

m (Rossdonaldson1 moved page Septal hematoma to Nasal septal hematoma)
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*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 pt who presents late after facial trauma with systemic symptoms
+
*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)
  
 +
==Clinical Features==
 
*Adults present with significant facial trauma and nasal fracture
 
*Adults present with significant facial trauma and nasal fracture
  
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**Rhinorrhea (25%)
 
**Rhinorrhea (25%)
 
**Fever (25%)
 
**Fever (25%)
 +
 +
==Differential Diagnosis==
 +
 +
==Diagnosis==
 +
*Usually clinical
  
 
==Management==
 
==Management==
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#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
+
#*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 b/l anterior nasal packing w/ nasal tampons coated w/ topical abx
 
#Perform b/l anterior nasal packing w/ nasal tampons coated w/ topical abx
##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
 
##Amoxicillin/clavulanate for uncomplicated
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==Disposition==
 
==Disposition==
*Discharge w/ 24hr ENT or ED follow-up
+
*Discharge with 24hr ENT or ED follow-up
  
 
==See Also==
 
==See Also==

Revision as of 17:59, 3 December 2015

Background

  • Requires immediate incision and drainage to prevent nasal septum necrosis
    • Can lead to saddle nose deformity, nasal septum abscess
  • 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
  • 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

Diagnosis

  • Usually clinical

Management

  1. Place lidocaine-soaked cotton pledgets in nose for 5min
  2. Achieve visualization with nasal speculum
  3. Make horizontal incision superficially through the mucosa and the perichondrium
    • Ensure that you do not incise the cartilagenous septum
  4. Evacuate clot with Frazier suction or forceps
  5. Insert single 1/8in iodoform gauze wick into the incision to avoid premature closure
  6. Perform b/l anterior nasal packing w/ nasal tampons coated w/ topical abx
    • Prevents reaccumulation of clot and keeps septum midline
  7. Give oral abx (cover S. aureus, H. flu, S. pneumo)
    1. Amoxicillin/clavulanate for uncomplicated
    2. Clindamycin if abscess suspected

Disposition

  • Discharge with 24hr ENT or ED follow-up

See Also

References