A septal hematoma is a bruise or bleeding within the nasal septum. The septum of the nose 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 in the area, allowing fluid and blood to collect under the lining.
- 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.
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.
If this injury is treated in a timely fashion, you can expect full healing.
If the hematoma has been present for some 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 collapse of the area, resulting in a cosmetic 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.
Although prevention of the injury may not be possible, early recognition and treatment will prevent complications and allow the septum to heal properly.
Bluestone CD, Stool SE, Alper CM, et al. Pediatric Otolaryngology. 4th ed. Philadelphia, Pa: WB Saunders; 2002.
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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