According to research, the nose is the most frequently injured facial structure. The injuries occasionally disrupt the tender nasal blood vessels leading to accumulation of blood and fluid under the nasal lining.
The most common complication resulting from the accumulation of fluid/blood under the nasal lining is septal hematoma, which is the accumulation of blood within the septum of the nose.
Septal hematoma usually results from injury to the soft tissue of the septum. This condition is more common in children compared to adults because their septums have a more flexible lining and thicker.
In adults, septal hematoma occurs as a result of facial trauma or nasal fracture. In children, the condition may result from minor nasal trauma like collisions with stationary objects or simple falls.
2. The Nasal Septum
This is the region that separates the two nostrils. It is normally 2 to 4 millimeters thick.
The thickness of the nasal septum varies with age and from one individual to another.
The most common signs and symptoms associated with septal hematoma include nasal congestion, difficulties in breathing, change in the shape/integrity of the nose and painful swelling of the nasal septum.
In children, most common signs include rhinorrhea, pain, nasal obstruction and fever.
On average, these symptoms usually manifest within 1 to 3 days.
Diagnosis of septal hematoma is usually done by inspecting the septum of the nose with an otoscope or a speculum.
The presence of a bluish or reddish fluctuance is a clear indication of hematoma. Newly formed septal hematoma might not be ecchymotic hence requiring palpation to be confirmed.
Palpation is best done by inserting a gloved small finger inside the patient’s nose and palpating along the entire septum, feeling for fluctuance, swelling or widening of the septum.
5. Confirmation of Septal Hematoma
After proper examination of the nose by your health care provider, he/she will touch the swollen septum with a cotton swab or an applicator.
If the area is soft and easy to press, then this could suggest the presence of a hematoma. A healthy nasal septum is usually rigid and thin.
Aspiration of clotted blood is done using a syringe. After suction of the blood clot, the area is carefully irrigated using sterile normal saline.
A small penrose drain & suture is placed in place after which cotton/gauze or nasal tampon is placed inside the nose to drain blood.
Broad spectrum antibiotics are administered to keep bacterial infections at bay.
7. Period of Healing
If the injury is treated early, full healing should take place in a period of three weeks.
8. Common Complications
If the hematoma is left unattended for a long period of time, an infection may occur.
Common complications that might arise include nasal deformity, fever, septal abscess, nasal congestion and formation of a hole in the septum.
9. Period of Infection
Generally, the front portion of the nasal septum is made up of a thin cartilaginous plate with closely adherent mucosa and perichondrium.
Under impact, blood vessels of the mucosa are torn leading to the accumulation of blood between the cartilage and the perichondrium.
The presence of stagnant blood might lead to bacterial multiplication and formation of an abscess. A hematoma becomes infected within three days of injury or trauma.
10. How to Prevent Infections
The most effective way to prevent nasal septal hematoma infection is through early diagnosis and treatment. This keeps common complications at bay, allowing quicker healing of the nasal septum.
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