Septalhematom

A septal hematoma is a collection of blood that forms in the nasal septum between the mucoperichondrium and the septal cartilage. It most often follows blunt nasal trauma or nasal surgery and can act as a space-occupying lesion that disrupts the normal blood supply to the septal cartilage.

Causes and risk factors include blunt nasal injury, provocative procedures such as rhinoplasty or septoplasty, and, less commonly, spontaneous development. Children are said to be at higher risk because the septal cartilage is more vulnerable to injury and to rapid swelling after trauma.

Clinical features typically include acute nasal obstruction, tenderness, and swelling along the nasal septum. The septum may appear swollen or bulging from within the nasal cavity, sometimes with a bluish or purplish tint. Fever is not always present unless infection develops. Diagnosis is mainly clinical, supported by nasal endoscopy; imaging (such as CT) is used when extension or alternative diagnoses are a concern.

Management requires urgent evaluation by an ear, nose, and throat specialist. The core treatment is drainage of the hematoma to relieve pressure on the cartilage and prevent necrosis. This is followed by intranasal packing and often a short course of antibiotics to prevent infection. Monitoring for reaccumulation is important, and activity should be limited to prevent recurrence.

Complications from delayed treatment can be serious, including cartilage necrosis, saddle nose deformity, septal abscess, or, rarely, orbital or intracranial infections. With prompt drainage and appropriate care, the prognosis is generally favorable.