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Practice Easily missed?

Nasal septal haematoma

BMJ 2014; 349 doi: (Published 04 November 2014) Cite this as: BMJ 2014;349:g6075
  1. Leigh N Sanyaolu, core surgical trainee (ear, nose, and throat),
  2. Sarah E J Farmer, specialist registrar (ear, nose, and throat),
  3. Patrick J Cuddihy, consultant (ear, nose, and throat)
  1. 1Department of Otolaryngology, Royal Gwent Hospital, Newport, UK
  1. Correspondence to: L N Sanyaolu
  • Accepted 18 August 2014

The bottom line

  • Inspect the nasal septum after any nasal trauma, no matter how trivial, to assess for a septal haematoma

  • Common presenting features include nasal obstruction, pain, rhinorrhea, and fever

  • It may be visible as a fluctuant swelling arising from the nasal septum, more commonly (but not always) bilateral

  • Refer all patients suspected of having a septal haematoma as an emergency to the ear, nose, and throat department

  • Septal haematomas can cause severe cosmetic nasal deformities as well as serious life threatening infective complications

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.

What is a nasal septal haematoma?

Nasal trauma is extremely common, with the nasal bones being the third most commonly fractured bone in the human body.1 2 3 In about 90% of nasal fractures the nasal septum is also injured.1 2 3 A potential serious complication of nasal trauma is a nasal septal haematoma. This is the development of a haematoma between the septal cartilage and the overlying mucoperichondrium.3 4 Damage to the septal cartilage can occur within 24 hours, and if untreated it can rapidly lead to irreversible septal …

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