Nasal septal hematoma is a collection of blood under the mucoperichondrium or mucoperiosteum of the nasal septum caused by trauma or surgery. Symptoms include nasal obstruction, pain, rhinorrhea, and fever. Examination reveals asymmetry of the septum with bluish or reddish swelling. Treatment involves urgent drainage of the clot under local anesthesia to prevent complications like abscess or deformity. Late drainage can lead to issues like a saddle nose deformity or sinusitis. Proper technique involves incising the mucosa and suctioning out the clot while irrigating with saline.

1. Nasal Septal
Hematoma
Drainage
Adib Mursyidi
ETD SASMEC @IIUM

2. Introduction
 Nose  commonly injured facial structure  trauma resulting in septal hematoma is an
exception  serious complication
 Collection of blood under the mucoperichondrium or mucoperiosteum of nasal septal
cartilage or bone  unilateral or bilateral
 The key  to prevent an abscess  result in a saddle nose deformity or septal
perforation

3. Etiology
 Trauma (most commonly)
 Children  minor injury (or suspected NAI)
 Iatrogenic  post op complication (septal correction, endoscopic sinus
surgery or turbinate surgery)
 Atraumatic  adverse effect of antiplatelet/anticoagulant drugs.

4. Nasal Septal Hematoma

5. History & Physical Exam
 A nasal hematoma  present within the first 24 to 72 hours after trauma.
 Symptoms: nasal obstruction (95%) unilateral or bilateral, pain (50%), rhinorrhea (25%),
and fever (25%).
 Clinical examination  nasal speculum/direct visualization
 Asymmetry of the septum with bluish or reddish mucosal swelling suggests a
hematoma.
 Direct palpation is carried out by gently inserting the little finger into the patient's nose.

6. Blood Supply

7. Treatment & Drainage
Drain urgent with local anesthesia
 PPEs
 Topical anesthesia
 Light source (head-lamp or otoscope)
 Nasal speculum
 Suction apparatus
 Gloves
 Needle, 18-20 gauge (Ga)
 Syringe, 5 mL
 Scalpel, No. 11 blade or 15 blade
 Nasal tampon
 Gelfoam (absorbable gelatin)
 Surgicel (oxidized cellulose)

8. Technique
 Needle aspiration under topical anesthesia can be performed using an 18- to 20-ga needle
 Specimens should be sent for gram stain and aerobic and anaerobic cultures  Systemic
antibiotics should then be administered
 To drain the hematoma  incise the mucosa over the area of greatest fluctuance without incising
cartilage
 Suction out the clot  then irrigate with sterile normal saline.
 Pack both nostrils, as in anterior epistaxis  packing remain in place at least 24hours up to 2-3
days.

9. Technique

11. Complications
Late drainage will lead the complications
 Septal abscess
 Saddle nose
 Deviated nasal septum
 Sinusitis
 Faciall cellulitis
 Sepsis
 Bacteremia
 Meningitis

12. Thank youReferences:
1.https://www.ncbi.nlm.nih.gov/books/NBK470247/
2. https://emedicine.medscape.com/article/149280-overview
3. Uptodate