Septal hematoma

Definition

A septal hematoma is a bruise or bleeding in the septum -- the part of the nose that separates the two nostrils.

Causes, incidence, and risk factors

A broken nose or any soft tissue injury to the area may cause a septal hematoma. This can occur more often in children because their septums are thicker and have a more flexible lining covering the area.

An injury disrupts the blood vessels, allowing fluid and blood to collect under the lining.

Symptoms

  • Blockage in breathing
  • Nasal congestion
  • Painful swelling of the nasal septum

Signs and tests

Your health care provider will look into your nose to see if there is soft tissue swelling in the area separating the two sides of your nose. Gentle touching with an applicator or Q-tip will show that the area is soft and can be pressed down. The nasal septum is normally thin and rigid.

Treatment

Your health care provider will immediately drain the blood by making a small cut in the lining over the hematoma. Once the blood is removed, gauze or cotton is placed inside the nose.

Expectations (prognosis)

If this injury is treated quickly, you should fully heal.

Complications

If you have had the hematoma for a long time, it may become infected and will be painful. You may develop a septal abscess and fever.

An untreated septal hematoma may lead to a hole in the area separating the two nostrils. This can cause nasal congestion. Or, the area may collapse, leading to a deformity called a saddle nose.

Calling your health care provider

Any nasal injury resulting in nasal congestion or pain may develop into a septal hematoma. You should call your health care provider, who may refer you to an ear, nose, and throat (ENT) specialist. Treatment by an ENT specialist can be done in an office setting.

Prevention

Although prevention of the injury may not be possible, early recognition and treatment will prevent complications and allow the septum to heal properly.

Figures

References

Chegar BE, Tatum SA III. Nasal fractures. In: Flint PW, Haughey BH, Lund LJ, et al, eds. Cummings Otolaryngology: Head & Neck Surgery. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2010:chap 35.

Krakovitz PR, Koltai PJ. Pediatric facial fractures. In: Flint PW, Haughey BH, Lund LJ, et al, eds. Cummings Otolaryngology: Head & Neck Surgery. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2010:chap 189.

Haddad J Jr. Acquired disorders of the nose. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 369.

Revision

Last reviewed 8/31/2011 by Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; Seth Schwartz, MD, MPH, Otolaryngologist, Virginia Mason Medical Center, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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