A Swollen Nose – Nasal Septal Hematoma

Abstract

A 6-y-old boy presented to Otorhinolaryngology emergency clinic with a 1-day history of bilateral nasal obstruction, mouth breathing and pain on the dorsum of the nose. The symptoms occurred after a blunt trauma to the nose due to an accidental fall from bed. Examination revealed a bilaterally symmetrical, bluish, fluctuant swelling in the anterior part of the nasal septum, completely obstructing both the nasal cavities (Fig. 1), along with nasal tip tenderness. The findings were classical of a nasal septal hematoma. Rest of the systemic examination was unremarkable. The child underwent incision and drainage under general anesthesia and merocele packs were inserted for 3 d. Antibiotic cover against Staphylococcus aureus was given for 5 d. The child remained well at 4mo follow-up visit. A nasal septal hematoma occurs when blood collects in the space between the septal cartilage and the overlying mucoperichondrium [1, 2]. It is classically bilateral and follows nasal trauma, although bleeding disorders, violent sneezing and anticoagulant drugs like aspirin and warfarin are also attributed to its development. The buckling force strips the perichondrium off the cartilage, tearing the submucosal blood vessels, resulting in a hematoma [1, 2]. If not drained immediately, the cartilage may undergo necrosis as it is deprived of its nutrition, leading to saddle nose deformity, supra tip collapse and columellar retraction. Undue delay in diagnosis and treatment can also lead to septal abscess, septal perforation and direct spread of infection to cavernous sinus via emissary veins [3]. Hence, all patients with nasal trauma should be evaluated for septal hematoma, and immediate surgical drainage along with nasal packing for 2–3 d (to prevent recurrence) is warranted to avoid complications. Authors Contribution AC, PS and CAS were involved in the clinical care of the patient, literature review, and manuscript preparation. All authors read and approved the finalmanuscript. CAS is the guarantor for this article.