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CLINICAL PROCEDURES
 Septal and Auricular Hematoma
            Drainage
LAYERS OF THE NASAL SEPTUM
           MUCOSA

       PERICHONDRIUM
        HEMATOMA
       SEPTAL CARTILAGE
COMPLICATIONS OF SEPTAL
     HEMATOMA
Perforation
Saddle
Deformity
Treatment
Septal Hematoma
 Drainage Video
Layers of the Pinna
      Skin
   HEMATOMA
   Perichondrium
   Elastic Cartilage
   Perichondrium
         FAT
          Skin
Complications
Anesthesia Options
SEPTAL HEMATOMA              AURICULAR HEMATOMA
• Topical Lidocaine          • Local Infiltation
• Local Infiltration         • Auricular Block
• Infraorbital Nerve Block
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
Clinical procedures: Septal/Auricular Hematoma

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Clinical procedures: Septal/Auricular Hematoma

Editor's Notes

  1. Stress on mucoperichondrium ruptures submucosal blood vessels, creating hemorrhage/hematoma formation
  2. 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
  3. PEARL: if unable to visualize a hematoma, use a gloved finger to palpate the septum for a bulging/fluctuance
  4. Incise, Drain with sxn if necessary, excise small amt. of mucosa, pack to drain, place anterior nasal pack, ppx antibiotics
  5. Needle aspiration is an alternative, with subsequent packing. More likely to develop recurrent collection. May re-aspirate at time of packing removal if needed.
  6. 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
  7. Incise with blade along natural lines, milk/sxn hematoma out, apply bolster dressing
  8. Invasive Ear Bolster by ENT
  9. Another Invasive Ear Bolster
  10. Noninvasive Ear Bolster Dressing for Use in the ED