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Septal hematoma: causes, symptoms, complications and treatment

Definition: Blood collection in the nasal septum between mucoperichondrium & cartilage. While hematoma is similar to blood clot or bruise, it is dangerous if left untreated as it could damage the tissue of the septum and cause infection.

Etiology (causes and risk factors):

It is not certain why some people develop "hematoma" after a nose injury while others don't. Some scientists state that it is about how nose injury affects the mucosa, i.e if the injury ccauses blood vessels break but not the mucous membranes, this allows blood to accumulate under mucous membrane causing hematoma.
septal-hematoma

The risk factors are:
  • Traumatic: accidental or surgical.
  • Spontaneous: Bleeding tendency.

Symptoms of septal hematoma: 

Hematoma can develop hours, days or even weeks after injury to the nose, Patients should seek medical advice after any nasal injury and it is impotant to exclude nose fracture. Hematoma patients usually come to the clinic with the following symptoms:

  • History of trauma, or surgery.
  • Bilateral nasal obstruction (blockage), it might be unilateral, Depending on the location of the hematoma, blockage may be worse on one side more than the other.
  • If large hematoma, the patient may experience difficulty in breathing.
  • If secondary infection occurs, the patient will have intense pain, fever, swollen lymph nodes and even nasal deformity.
  • It is an emergency in newborn babies as they are obligatory nose breathers.

Signs: 

  • Bilateral fluctuant swelling, on both sides of septum.
  • Aspiration reveals blood.

Complications of Septal hematoma: 


Treatment of Septal hematoma:

drainage-septal-hematoma

  • Aspiration, if the patient visits the doctor early.
  • As newborn babies are obligatory nose breathers, they may need additional care including the placement of a tube to help them breathe while the hematoma heals.
  • Incision & evacuation: Drainage under local anathesia usually, but some cases (particularly babies and very young children) may need general anesthesia.Transverse incision, to avoid disturbance of mucociliary transport. Put a nasal pack for 24hours, and give antibiotics.

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