Nasal septal haematoma

Nasal septal haematoma

• is a blood-filled cavity between the cartilage and the supporting perichondrium (1)
• it is a condition with similarities to the subchondral haematoma seen in ear injuries - and in fact may have similar clinical consequences.
• it occurs when there has been a shearing injury causing the perichondrium to be stripped from the underlying cartilage. Unless corrected, necrosis results as the cartilage is dependent upon the perichondrium for its blood supply, by diffusion.
• treatment
  • urgent drainage and firm nasal packing to ensure adherence of the perichondrium to the cartilage.
  • it should be aspirated immediately or can be incised with the aid of local anesthesia (1)
  • antibiotics are recommended.
• complications of a neglected haematoma include:
  • septal abscess - causing accelerated cartilage necrosis, and possibly, intracranial sepsis
  • collapse of the nasal bridge - from septal fibrosis; also known as saddle nose

Reference:

• (1) Corry J. Kucik. Management of acute nasal fractures.Am Fam Physician 2004;70:1315-20