Clinical Procedures for Draining Septal and Auricular Hematomas
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This document discusses the clinical procedures for draining septal and auricular hematomas. It covers the layers of the nasal septum and pinna, complications that can arise like perforation and saddle deformity, and treatment which involves drainage. It provides options for anesthesia as well as general aftercare instructions to follow-up promptly, take antibiotics to prevent infection, avoid medications that could cause rebleeding, and return if signs of infection occur.
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Clinical Procedures for Draining Septal and Auricular Hematomas
- 1. CLINICAL PROCEDURES Septal and Auricular Hematoma Drainage
- 4. LAYERS OF THE NASAL SEPTUM MUCOSA PERICHONDRIUM HEMATOMA SEPTAL CARTILAGE
- 5. COMPLICATIONS OF SEPTAL HEMATOMA
- 6. Perforation
- 10. Treatment
- 13. Septal Hematoma Drainage Video
- 15. Layers of the Pinna Skin HEMATOMA Perichondrium Elastic Cartilage Perichondrium FAT Skin
- 16. Complications
- 22. Anesthesia Options SEPTAL HEMATOMA AURICULAR HEMATOMA • Topical Lidocaine • Local Infiltation • Local Infiltration • Auricular Block • Infraorbital Nerve Block
- 23. General Aftercare for Both • Follow up in 24 hours with specialist • Anti-staphylococcal PPX antibiotics • Avoid ASA, NSAIDs to prevent rebleed • Return precautions for infection
Editor's Notes
- Stress on mucoperichondrium ruptures submucosal blood vessels, creating hemorrhage/hematoma formation
- Blood under perichondrium separates avascular cartilage from blood supply, resulting in necrosis in 3 days. Abscesses may form 6-7 days out from injury. Dangerous complications include osteomyelitis, orbital/intracranial abscess, meningitis, and cavernous sinus thrombosis
- PEARL: if unable to visualize a hematoma, use a gloved finger to palpate the septum for a bulging/fluctuance
- Incise, Drain with sxn if necessary, excise small amt. of mucosa, pack to drain, place anterior nasal pack, ppx antibiotics
- Needle aspiration is an alternative, with subsequent packing. More likely to develop recurrent collection. May re-aspirate at time of packing removal if needed.
- Again, collection of blood between the perichondrium and the elastic cartilage robs avascular cartilage of necessary blood flow/nutrients and can lead to destruction and or abscess formation
- Incise with blade along natural lines, milk/sxn hematoma out, apply bolster dressing
- Invasive Ear Bolster by ENT
- Another Invasive Ear Bolster
- Noninvasive Ear Bolster Dressing for Use in the ED