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.1 Suspect a nasal septal hematoma, although an uncommon complication of nasal trauma, in any individual who has sustained a nasal injury.2,3 All 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
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 include sports injuries and child abuse.5,6 Iatrogenic nasal 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 nasal septal hematoma.
Nasal 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 (Figures 171-1 & 2). 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
Bilateral nasal septal hematomas creating a partial obstruction.
A small left-sided nasal septal hematoma.
Distinguishing an uncomplicated nasal 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 nasal septal hematomas that occur following nasal trauma. Nasal septal abscesses generally are larger and more painful than uncomplicated nasal 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 nasal septal abscess is cartilage necrosis that results in nasal structural collapse and a saddle nose deformity (Figure 171-3).
The saddle nose deformity.
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 ...