Nasal septal hematoma

Revision as of 17:59, 3 December 2015 by Rossdonaldson1 (talk | contribs) (Differential Diagnosis)

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

Maxillofacial Trauma

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