What is Nasal Septal Hematoma?
The nose is the part of the face that gets injured the most. Usually, most injuries to the nose aren’t severe and don’t need immediate attention. However, a certain kind of injury called a septal hematoma is an exception. This injury is rare and serious, and it happens when blood collects under the skin that covers the cartilage or bone in the middle of our nose, called the nasal septum. This can happen on one or both sides of your nose, especially if the injury was severe.
The aim is to ensure that an abscess, or a pocket of pus formed by the infection, doesn’t form. This is because it could lead to a “saddle nose deformity,” where your nose has a sunken look, or a “septal perforation,” where a hole forms in the nasal septum, which separates your nostrils. Both of these complications can permanently change the shape of your nose.
What Causes Nasal Septal Hematoma?
A septal hematoma is generally a result of a trauma to the nose. This injury could be due to sports-related incidents, car accidents, falls, assault, or occupational hazards. Even a small injury could lead to a septal hematoma, particularly in children. If a child develops a septal hematoma without an evident injury, it could indicate potential child abuse.
A septal hematoma could also result from certain surgical procedures involving the nose, such as corrective nasal septum surgery, sinus surgery, or turbinate surgery. These are known as iatrogenic septal hematomas.
In very rare cases, a septal hematoma could occur without any trauma. This is usually seen in patients who have an abnormal tendency to bleed or in patients taking drugs that thin the blood or prevent clot formation, referred to as antiplatelets/anticoagulants.
Risk Factors and Frequency for Nasal Septal Hematoma
A septal hematoma, although rare and can affect people of all ages, mainly goes unnoticed, specifically in children, until complications arise. This condition happens to people who have had a nasal injury and report to the ear, nose, and throat clinic, which the occurrence ranges between 0.8% to 1.6%. The real number of septal hematoma cases is still not known, as many incidents are usually overlooked.
Signs and Symptoms of Nasal Septal Hematoma
A nasal hematoma, which is a collection of blood inside the nose, usually appears within 24 to 72 hours after an injury, although it can sometimes show up later. The most commonly experienced symptom of a nasal hematoma is a blocked nose, which can affect one or both nostrils depending on the hematoma. Other symptoms may include pain, runny nose, and fever. These symptoms can often be vague, so if someone has a reshaped or painful nose after an injury, or if their blocked nose doesn’t clear up with the use of a decongestant or after removing a blood clot, a nasal hematoma could be a possibility.
A medical examination, using a tool to look inside the nose like a nasal speculum or otoscope, can usually confirm a nasal hematoma. If there are any blood clots, these should be suctioned out. A hematoma might be suggested by asymmetrical swelling of the nasal septum, the wall between the nostrils, which may look bluish or reddish. A fresh hematoma might not always be visible as a bruise and might only be detected by feeling it. The doctor can do this by gently inserting their little finger into the patient’s nostril. A hematoma will feel soft and sponge-like, unlike a crooked septum, which will feel firm and bend in on the other side. Another sign of a nasal hematoma is that its size doesn’t decrease after using a decongestant spray like oxymetazoline 0.05%.
- Usually appears within 24 to 72 hours after an injury
- Most common symptom is a blocked nose
- Other symptoms may include pain, runny nose, and fever
- Nasal injury, reshaped nose or nose pain following an injury, could suggest a nasal hematoma
- Blocked nose doesn’t clear up with a decongestant or after removing a blood clot
- Medical examination required for confirmation
- Swelling of the nasal septum may look bluish or reddish
- Hematoma feels soft and sponge-like
- Size of the hematoma often doesn’t decrease with decongestant spray
Testing for Nasal Septal Hematoma
Most of the time, your doctor can diagnose a certain condition just by examining you and noting down your symptoms. They might touch certain areas of your body or ask you to perform simple movements to check for pain and discomfort. However, sometimes, it’s not so straightforward.
In these cases, where the condition is unclear or “equivocal” based on this physical examination alone, your doctor may need extra information to make a more accurate diagnosis. One way to do this is by using imaging techniques like a computed tomography (CT) scan or a magnetic resonance imaging (MRI) scan.
These are sophisticated imaging methods that allow your doctor to ‘look inside’ your body without needing to perform surgery. Like taking a photograph, these scans create images of the inside of your body – including your bones, muscles, and organs – that your doctor can then study to better understand what’s going on.
So, in situations where a physical examination isn’t enough to confirm a diagnosis, your doctor might consider using these imaging techniques to get a clearer picture of what’s going on inside your body.
Treatment Options for Nasal Septal Hematoma
A nasal septal hematoma is a condition where blood collects in the nasal septum, the thin wall between your nostrils. If you have this condition, it’s important that it’s treated as soon as possible to avoid harmful complications.
Treating the condition often involves draining the blood out of the septum. This is usually done with a local anesthetic – a numbing agent applied to a specific area. In some cases, however, a general anesthetic may be used, which puts you to sleep for the procedure. This is often the case for children or adults who are particularly nervous about the procedure.
Before starting the procedure, the doctor will make sure that they have all the necessary tools. This includes numbing medication, a light source for visibility, devices for opening up your nose and removing the blood, protective gloves, and different medical tools like needles, scalpels, tampons designed for use in the nose, and materials that can help your body heal and prevent further bleeding.
For the actual procedure, you’ll lie in a relaxed position with your head slightly raised. The doctor will then use a needle to drain smaller hematomas. For larger ones, they might need to make a small cut over the bulging area to remove the blood clot. After the clot is removed, the doctor cleans the area with saline. A commercial nasal tampon maybe used to prevent further blood accumulation.
To promote better drainage and prevent premature closure of the incision, they might remove a tiny portion of the skin from the edge of the incision. They’ll also insert a small Penrose drain – a kind of tube used to maintain drainage – in the opened hematoma cavity. Finally, they’ll pack both sides of your nose to prevent more blood from accumulating.
You will be given antibiotics to prevent any potential infections. The pack and drain would typically remain in place for 2 to 3 days. The doctor would remove them only when there’s no additional drainage for at least a day.
After the procedure, it’s essential that you follow up with your doctor regularly to prevent any delayed complications . It’s crucial that your doctor keeps an eye on the affected area to ensure you’re healing correctly and that no other problems occur.
What else can Nasal Septal Hematoma be?
When looking at various medical conditions, there are several possibilities that you might come across, such as:
- Angiofibroma (a type of benign skin tumor)
- Adenoid hypertrophy (an enlargement of the adenoids)
- Chronic sinusitis (long-term inflammation of the sinuses)
- Chondromas (a slow-growing tumor made up of cartilage cells)
- Hemangioma (a birthmark that most commonly appears at birth or in the first or second week of life)
- Malignancies (cancerous growths)
- Nasal polyps (soft, painless growths inside your nasal passages)
- Papillomas (small, wart-like growths)
- Pyogenic granulomas (small, red, benign growths that look like raw hamburger meat)
- Rhinitis (inflammation and swelling of the mucous membrane of the nose)
- Septal abscess (a collection of pus between the cartilage or bony septum and its normally applied mucoperichondrium or periosteum)
- Septal deformities (a condition where the thin wall between your nostrils leans to one side)
Each of these conditions has its own set of symptoms and potential treatments, so if you are experiencing any health problems, it is important to seek help from a healthcare professional who can provide a proper diagnosis and treatment plan.
Possible Complications When Diagnosed with Nasal Septal Hematoma
A nasal septal abscess, a serious problem that can arise from a septal hematoma, can spread quickly to nearby parts of the body, including the sinuses and the brain.
Moreover, the growing hematoma can affect the blood supply to the cartilage causing it to die and collapse. This phenomenon might lead to a deformity in the nose known as a saddle nose.
Common Complications:
- Nasal septal abscess spreading to sinuses and brain
- Death of cartilage due to lack of blood supply
- Deformation of the nose (saddle nose deformity)
Recovery from Nasal Septal Hematoma
The patient needs to visit the clinic within 1 to 2 days to confirm that the accumulated blood (hematoma) has been properly drained. It might be necessary to remove the packing from their nose to allow for a thorough checkup.
