Nasal septal haematoma is a blood-filled cavity between the cartilage and the supporting perichondrium of the nose
Usually it occurs after trauma to the nose, associated fractures to the nose or to facial structures. It occurs when there has been a shearing injury causing the perichondrium to be stripped from the underlying cartilage. Unless corrected, necrosis results as the cartilage is dependent upon the perichondrium for its blood supply, by diffusion.
Symptoms of a haematoma of the nasal septum usually include: Nasal blockage, pain, swelling and discoloration, redness, or bruising, bleeding from the nose and headache
Treatment
Urgent incision and drainage and firm nasal packing to ensure adherence of the perichondrium to the cartilage. If it happens after trauma, it should be aspirated immediately or can be incised with the aid of local anesthesia .Antibiotics and anti-inflammatory analgesics are recommended. If needed a small drain is sutured in place and silastic splints inserted before nasal packing. The drain and splints are removed after a week.
Complications of a neglected haematoma include:
Septal abscess – causing accelerated cartilage necrosis, and possibly, intracranial sepsis
collapse of the nasal bridge – from septal fibrosis; resulting in deformity also known as saddle nose
Dr Paulose is an ENT Consultant Plastic and Laser Surgeon with over 35 years of experience covering in Ear, Nose and Throat procedures, specializing in Laser Surgery and conventional medicine across India, U.K. and Middle East. He is currently engaged with the Jubilee Hospital, in Kerala, India.
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