Overview
Nasal septal hematoma (NSH) is a collection of blood within the cartilaginous septum of the nose, often resulting from trauma and potentially leading to septal abscess if untreated. It is considered an otorhinolaryngology emergency due to the risk of septal necrosis and airway obstruction 1.Diagnosis
Clinical Presentation: Symptoms include nasal obstruction, swelling, pain, and epistaxis (more common in NSH) 1.
Physical Examination: Identification of swelling and tenderness over the nasal septum is crucial 1.
Imaging: Not routinely required but may be used to confirm diagnosis or assess complications 1.
Laboratory Tests: Not typically indicated unless systemic infection is suspected 1.Management
Surgical Drainage: Early surgical evacuation of the hematoma is essential to prevent complications 1.
Antibiotics: Considered if signs of infection (fever, purulent discharge) are present, though specific drug classes/doses are not detailed 1.
Monitoring: Close monitoring for signs of sepsis or airway compromise is critical 1.
Follow-Up: Long-term evaluation for potential septal deformity is recommended, especially in pediatric patients 1.Special Populations
Pediatrics: Common in children, with associated nasal fractures more frequent in NSH cases; long-term nasal deformity assessment is important 1.
Comorbidities: No specific management differences noted for elderly or comorbid conditions in the provided abstracts 1.Key Recommendations
Prompt Surgical Intervention: Early surgical drainage of the nasal septal hematoma is crucial to prevent complications such as septal necrosis and abscess formation (Evidence: Strong 1).
Monitor for Infection: Closely monitor patients for signs of infection, including fever and purulent discharge, and consider empirical antibiotic therapy if present (Evidence: Moderate 1).
Long-Term Follow-Up: Reevaluate pediatric patients for potential long-term nasal septal deformities post-treatment (Evidence: Expert opinion 1).References
1 Sayin I, Yazici ZM, Abakay MA, Saygan GB, Gunes S. Nasal Septal Hematoma and Abscess in Children: An Uncommon Otorhinolaryngology Emergency Revisited. The Journal of craniofacial surgery 2021. link