How is septal hematoma treated in patients with nasal fractures?

Updated: Dec 06, 2018
  • Author: Samuel J Haraldson, MD; Chief Editor: Craig C Young, MD  more...
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High-force midfacial injuries may involve structures other than the nose itself.

  • Septal hematoma

    • This is a common and serious complication of nasal trauma. Septal hematomas are collections of blood in the subperichondrial space. This places pressure on the underlying cartilage, resulting in irreversible necrosis of the septum. The patient also becomes predisposed to infection. A saddle deformity may develop from loss of tissue.

    • Drainage procedure: Septal hematomas must be drained immediately upon their being found. Cotton pledgets soaked in 4% cocaine are used for topical anesthesia. A scalpel incision must be made to allow drainage. A small Penrose-type drain is placed to prevent reaccumulation. Finally, nasal packing is placed. The patient should be started on oral antibiotics with anti-staphylococcal coverage.

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