eMedicine Specialties > Clinical Procedures > Otolaryngologic and Dental Procedures

Drainage, Nasal Septal Hematoma

Author: Jessica Ngo, MD, Clinical Instructor, Department of Emergency Medicine, Stanford Hospital
Coauthor(s): Erik D Schraga, MD, Consulting Staff, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates; Consulting Staff, Permanente Medical Group, Kaiser Permanente, Santa Clara Medical Center
Contributor Information and Disclosures

Updated: Mar 29, 2009

Introduction

The nose is the most frequently injured facial structure. In the setting of trauma to the anterior nasal septum, hematoma formation may occur.1 Although septal hematomas are rare, early diagnosis and treatment is important to prevent abscess formation, septal perforation, saddle-nose deformity, and potentially permanent complications.2,3

The anterior portion of the nasal septum is composed of a thin cartilaginous plate with a closely adherent perichondrium and mucosa. Submucosal blood vessels are torn as buckling forces pull the perichondrium from the cartilage. Subsequently, blood may collect between the perichondrium and the septal cartilage. Bacterial proliferation and abscess formation may then result from the presence of stagnant blood. A hematoma may become infected within 3 days of the trauma. See images below.

Normal nasal septum.

Normal nasal septum.

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Normal nasal septum.

Normal nasal septum.


Nasal septal hematoma.

Nasal septal hematoma.

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Nasal septal hematoma.

Nasal septal hematoma.


The nasal septum is normally 2-4 mm thick. If the cartilage is fractured, blood can dissect through the fracture line and form bilateral hematomas; therefore, both sides should be examined. According to a study by Canty et al, the most common symptoms noted in children were nasal obstruction (95%), pain (50%), rhinorrhea (25%), and fever (25%).4 Symptoms usually appear within the first 24-72 hours.

Nasal septal hematoma in adults typically occurs with significant facial trauma and nasal fracture. However, in children, nasal septal hematoma may be found with minor nasal trauma such as simple falls, collisions with stationary objects, or minor altercations with siblings.5 Additionally, the presence of nasal septal hematoma with or without concomitant injuries should raise suspicion for child abuse, especially in infants and toddlers.

A careful examination is important for anyone who sustains nasal trauma. Signs of external trauma, such as nasal deformity, epistaxis, or significant pain, are associated with a septal hematoma. However, a septal hematoma may be present without any signs of external trauma.1

A septal hematoma can usually be diagnosed by inspecting the septum with a nasal speculum or an otoscope. Asymmetry of the septum with a bluish or reddish fluctuance may suggest a hematoma. Direct palpation may also be necessary, as newly formed hematomas may not be ecchymotic. The best way to palpate is to insert a gloved small finger into the patient’s nose and palpate along the entire septum, feeling for swelling, fluctuance, or widening of the septum. Blood clots should be suctioned to allow better visualization.

Indications

  • Urgent hematoma drainage is indicated for all nasal septal hematomas.6

Contraindications

  • No absolute contraindications exist to nasal septal hematoma drainage.

More on Drainage, Nasal Septal Hematoma

Overview: Drainage, Nasal Septal Hematoma
Treatment & Medication: Drainage, Nasal Septal Hematoma
Multimedia: Drainage, Nasal Septal Hematoma
References
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References

  1. Matsuba HM, Thawley SE. Nasal septal abscess: unusual causes, complications, treatment, and sequelae. Ann Plast Surg. Feb 1986;16(2):161-6. [Medline].

  2. Ambrus PS, Eavey RD, Baker AS, et al. Management of nasal septal abscess. Laryngoscope. Apr 1981;91(4):575-82. [Medline].

  3. Junnila J. Swollen masses in the nose. Am Fam Physician. May 1 2006;73(9):1617-8. [Medline].

  4. Canty PA, Berkowitz RG. Hematoma and abscess of the nasal septum in children. Arch Otolaryngol Head Neck Surg. Dec 1996;122(12):1373-6. [Medline].

  5. Toback S. Nasal septal hematoma in an 11-month-old infant: a case report and review of the literature. Pediatr Emerg Care. Aug 2003;19(4):265-7. [Medline].

  6. Chukuezi AB. Nasal septal haematoma in Nigeria. J Laryngol Otol. May 1992;106(5):396-8. [Medline].

  7. Agrawal N, Brayley N. Audit of nasal fracture management in accident and emergency in a district general hospital. J Eval Clin Pract. Apr 2007;13(2):295-7. [Medline].

  8. Menger DJ, Tabink I, Nolst Trenité GJ. Treatment of septal hematomas and abscesses in children. Facial Plast Surg. Nov 2007;23(4):239-43. [Medline].

  9. Ginsburg CM, Leach JL. Infected nasal septal hematoma. Pediatr Infect Dis J. Nov 1995;14(11):1012-3. [Medline].

  10. Huang PH, Chiang YC, Yang TH, Chao PZ, Lee FP. Nasal septal abscess. Otolaryngol Head Neck Surg. Aug 2006;135(2):335-6. [Medline].

  11. Savage RR, Valvich C. Hematoma of the nasal septum. Pediatr Rev. Dec 2006;27(12):478-9. [Medline].

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Further Reading

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Keywords

nasal septal hematoma, nasal trauma, broken nose, nasal hematoma, hematoma drainage, septal hematoma drainage, epistaxis, anterior nasal septum, hematoma, septal hematoma, septal abscess, septal perforation, saddle-nose deformity, nasal trauma, needle aspiration, meningitis, intracranial abscess, orbital cellulitis, cavernous sinus thrombosis, expanding hematoma, septal collapse, nasal bridge, septal cartilage

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Contributor Information and Disclosures

Author

Jessica Ngo, MD, Clinical Instructor, Department of Emergency Medicine, Stanford Hospital
Jessica Ngo, MD is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Erik D Schraga, MD, Consulting Staff, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates; Consulting Staff, Permanente Medical Group, Kaiser Permanente, Santa Clara Medical Center
Disclosure: Nothing to disclose.

Medical Editor

Prajoy P Kadkade, MD, Attending Physician and Assistant Professor, Department of Otolaryngology and Communicative Disorders, North Shore University Hospital (NSUH)-Long Island Jewish Hospital System, Albert Einstein College of Medicine; Director of Otolaryngology, North Shore University Hospital (NSUH)
Prajoy P Kadkade, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, and Medical Society of the State of New York
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: WebMD Salary Employment

 
 
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