Review Question - QID 215479

This patient presents with a septal hematoma after a traumatic injury to the nose. A saddle nose deformity due to avascular necrosis of the septal cartilage, and subsequent collapse, is a devastating complication that can occur if the hematoma is not appropriately managed.

Septal hematoma is a rare, but serious complication of nasal trauma. Fracture of the nasal cartilage causes rupture of the submucosal vessels which collects under the nasal septum perichondrium or periosteum. This may occur unilaterally or bilaterally, with the latter more likely to occur in severe trauma. Proper management includes urgent decompression under local anesthesia to prevent complications such as saddle nose deformity or septal abscess.

Marston et al. reviewed sports-related nasal trauma. They found the nasal bones are the most commonly injured facial bone. They identified nasal fractures, epistaxis, and septal hematoma as the most likely nasal injuries to require immediate management by a physician. They recommend urgent decompression of a septal hematoma to prevent devastating complications.

Henry and Hern reviewed traumatic injuries of the head and neck that are likely to be encountered in the emergency setting. They discussed appropriate management of a variety of injuries, including sports-related injuries such as auricular hematoma and septal hematoma. They recommend urgent decompression of a septal hematoma in the emergency department if a surgical specialist is unavailable to assist with management.

Illustration A shows two patients with saddle nose deformities as a result of septum necrosis.

Incorrect Answers:
Answer 1: Nasal obstruction is the most common symptom and is present ~95% of the time.
Answer 2: Septal hematoma can occur in patients of any age who sustain nasal trauma without predilection for specific age groups.
Answer 4: Nasal packing soaked in phenylephrine is a common treatment for epistaxis. Urgent decompression is the treatment of choice for septal hematoma.
Answer 5: Septal abscess is one of the most common complications if the hematoma is not decompressed as the pooled blood serves as a nidus for infection.