Ver el código de «Nasal septal hematoma»

==Background==
*Submucosal vessels disrupted
*Blood accumulates between perichondrium and cartilaginous septum
*Requires immediate incision and drainage to prevent nasal septum necrosis
**Can lead to saddle nose deformity, nasal septum abscess
**May be complicated by necrosis and perforation
*Suspect septum [[abscess]] in patient who presents late after [[facial trauma]] with systemic symptoms
*Ensure thorough examination of both nares - Nasal septum cartilage easily fractures (form bilateral hematomas)

==Clinical Features==
[[File:PMC5042625 OAMJMS-4-413-g001.png|thumb|Bilateral nasal septal hematoma]]
*Adults present with significant [[facial trauma]] and [[nasal fracture]]
*Dark purple hematoma against septum
*Common symptoms in peds, usually within first 24-72 hrs with even minor nasal trauma, include:
**Nasal obstruction (95%)
**Pain (50%)
**[[Rhinorrhea]] (25%)
**[[Fever]] (25%)

==Differential Diagnosis==
{{Maxillofacial trauma DDX}}

==Evaluation==
*Usually clinical
*[[Oxymetazoline]] will not change size of hematoma, as opposed to typical soft tissue edema from trauma

==Management==
#Place [[lidocaine]]-soaked cotton pledgets in nose for 5min
#Achieve visualization with nasal speculum
#Make horizontal incision superficially through the mucosa and the perichondrium
#*Ensure that you do not incise the cartilagenous septum
#Evacuate clot with Frazier suction or forceps
#Insert single 1/8in iodoform gauze wick into the incision to avoid premature closure
#Perform bilateral anterior nasal packing with nasal tampons coated with topical antibiotics
#*Prevents reaccumulation of clot and keeps septum midline
#Give oral [[antibiotics]] (cover [[S. aureus]], [[H. flu]], [[S. pneumo]])
#*[[Amoxicillin-clavulanate]] for uncomplicated
#**[[Clindamycin]] if [[abscess]] suspected

==Disposition==
*Discharge with 24hr ENT or ED follow-up

==See Also==
*[[Nasal fracture]]
*[[Maxillofacial trauma]]

==External Links==
*NEJM procedure video: https://www.youtube.com/watch?v=J5xzYyxgQ0g

==References==
<references/>

[[Category:Trauma]]
[[Category:ENT]]