Nasal septal haematoma

A 15 year old boy attends the emergency department with his mother after sustaining a nasal injury while playing rugby. His mother is worried that her son has fractured his nose. The boy says that his nose feels “very blocked” but otherwise he feels well. Examination shows a swollen nose with some associated bruising and the suspicion of bony nasal deviation to the left. Anterior rhinoscopy shows a bilateral cherry red swelling arising from the nasal septum. An immediate referral is made to the ear, nose, and throat department and the patient undergoes an emergency operation to incise and drain a septal haematoma, with no permanent damage to the nasal septum.