Nasal septal hematoma

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%)

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

• Nasal fracture
• Maxillofacial trauma