Septal Haematoma

This document discusses nasal septal haematoma, which occurs when blood accumulates between the cartilage and mucous membrane of the nasal septum, usually due to blunt facial trauma or nasal surgery. It can cause nasal obstruction if not treated. The document outlines examination and management approaches at different levels of care. At level 1, small haematomas can be aspirated with a needle, while larger ones at level 2 are drained under local anesthesia by making an incision, irrigating with saline, and leaving a drain in place. Antibiotics are also prescribed to prevent infection.

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Septal Haematoma

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Leez Khan

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NASAL SEPTAL HAEMATOMA

Written by Cathrine Irungu

Background Information

Definitions of levels of care (in this guideline)

● Level 1: Community healthcare worker/non-doctor
● Level 2: Medical doctor
● Level 3: ENT Surgeon

A nasal septal haematoma occurs when blood accumulates between the

cartilage and the overlying mucoperichondrium of the septum. The
cartilaginous septum receives its blood supply from the overlying mucous
membrane and these vessels pierce the mucoperichondrium to supply the
cartilage. If shearing forces tear these submucosal blood vessels, a
haematoma forms. This results in the separation of the mucoperichondrium
from the cartilaginous septum. If it occurs bilaterally, it results in septal
ischaemia with subsequent avascular necrosis and cartilage resorption. It is
usually unilateral but may be bilateral. It commonly occurs secondary to blunt
facial trauma but may also be secondary to nasal surgery or sinusitis. The
patient will usually develop nasal obstruction within 24-72 hours.

Examination

Don a pair of clean gloves, an apron or gown, a surgical face mask and eye
protection if available. A headlight is preferable as it allows one to use both
hands to examine but a torch or lamp can be used as well. Equipment should
include a nasal speculum if available.

General:
- Examine for a reddish or bluish nasal swelling on the anterior septum
- Examine for fluctuance, crepitus, septal deviation

Level 1:
- Examine the anterior nares and septum using a headlight or a torch
- Examine for fluctuance, crepitus, septal deviation

Level 2:
- Removal of clots if present followed by anterior rhinoscopy

Management

General:
- Use of 18-20 gauge needle for aspiration of small haematomas
- Larger haematomas are drained via incision and drainage
- Nasal packing is performed after drainage
- Antibiotics are prescribed to prevent infective complications

Level 1:
- In older children and adults, an 18-20 gauge needle for aspiration of
small haematomas

Level 2:
- In older children and adults, larger haematomas are drained under
local anaesthesia. In younger children, general anaesthesia is often
necessary
- Using a 10 or 15 gauge scalpel, an incision should made parallel to the
nasal floor and in the fluctuant part of the haematoma. In case of
bilateral haematoma, the incision should be staggered to prevent
septal perforation
- Saline irrigation using an 18-20 gauge cannula to clear the
haematoma
- A drain is left in situ and secured with sutures or quilting sutures are
placed
- Nasal packing may be performed bilaterally to aid prevention of
reaccumulation of the haematoma
- Antibiotics are prescribed to prevent infective complications
- Nasal pack and drain are removed after 48 – 72 hours

Septal Haematoma

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Septal Haematoma

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NASAL SEPTAL HAEMATOMA

Written by Cathrine Irungu

Definitions of levels of care (in this guideline)

A nasal septal haematoma occurs when blood accumulates between the

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