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Soft tissue and bony injuries of the nose are common because the nose is centrally located and the most anteriorly protruding structure of the face.1Suspect a nasal septal hematoma, although an uncommon complication of nasal trauma, in any individual who has sustained a nasal injury.2,3All individuals who have sustained nasal trauma must undergo a careful examination of the septum and nasal passages, regardless of the mechanism of injury or the findings on external examination.2

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Blunt trauma, either intentional or unintentional, is the most common cause of a nasal septal hematoma. Consider a bleeding diathesis if the hematoma develops after a seemingly trivial injury.2,4,5 Other etiologies for a septal hematoma include sports injuries and child abuse.5,6 Iatrogenic septal hematomas following nasal septal surgery are probably more common than reported in the literature. Evaluate patients who have had recent nasal surgery and present with complaints of pain and nasal obstruction for a possible septal hematoma.

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Septal hematomas are characterized by severe localized nasal pain, tenderness on palpation of the nasal tip, and a cherry-like swelling or bluish discoloration of the nasal mucosa emanating from the septum that obstructs all or a portion of the nasal passage1–3,7 (Figure 147-1). Evacuation must be performed to prevent complications.1,2,4,5 Patients require bilateral nasal packing, oral antibiotics, and close follow-up with an Otolaryngologist to prevent complications following the evacuation of the hematoma.2,4,8

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Figure 147-1
Graphic Jump Location

Bilateral nasal septal hematomas creating a partial obstruction.

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Distinguishing an uncomplicated septal hematoma from one that has become infected is difficult, particularly if there has been a delay of several days in seeking medical attention following the injury.2 Nasal septal abscesses are a rare complication of septal hematomas that occur following nasal trauma. Nasal septal abscesses generally are larger and more painful than uncomplicated septal hematomas. The overlying nasal mucosa is inflamed and occasionally has an inflammatory exudate.2 Local extension of the infection, if left untreated, into the cavernous sinus with subsequent intracranial infection is the most important potential complication.5,8 The most common complication of a septal abscess is cartilage necrosis that results in nasal structural collapse and a saddle nose deformity.

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The nose is both a sensory organ and a respiratory organ. It performs an important function for the entire body by providing both physical and immunologic protection from the environment.9 The nose aids in the formation of basic speech sounds.9 The supporting structure of the nose consists of bone, cartilage, and connective tissue. The nose, on frontal view, is in the shape of a pyramid of which approximately the upper two-fifths comprise the bony vault and the lower three-fifths comprise the ...

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