Diferencia entre revisiones de «Nasal septal hematoma»
Sin resumen de edición |
Sin resumen de edición |
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**Can lead to saddle nose deformity, nasal septum abscess | **Can lead to saddle nose deformity, nasal septum abscess | ||
**May be complicated by necrosis and perforation | **May be complicated by necrosis and perforation | ||
*Suspect septum abscess in patient who presents late after facial trauma with systemic symptoms | *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) | *Ensure thorough examination of both nares - Nasal septum cartilage easily fractures (form bilateral hematomas) | ||
==Clinical Features== | ==Clinical Features== | ||
*Adults present with significant facial trauma and nasal fracture | *Adults present with significant [[facial trauma]] and [[nasal fracture]] | ||
*Dark purple hematoma against septum | *Dark purple hematoma against septum | ||
*Common symptoms in peds, usually within first 24-72 hrs with even minor nasal trauma, include: | *Common symptoms in peds, usually within first 24-72 hrs with even minor nasal trauma, include: | ||
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**Pain (50%) | **Pain (50%) | ||
**Rhinorrhea (25%) | **Rhinorrhea (25%) | ||
**Fever (25%) | **[[Fever]] (25%) | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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==Diagnosis== | ==Diagnosis== | ||
*Usually clinical | *Usually clinical | ||
*Oxymetazoline will not change size of hematoma, as opposed to typical soft tissue edema from trauma | *[[Oxymetazoline]] will not change size of hematoma, as opposed to typical soft tissue edema from trauma | ||
==Management== | ==Management== | ||
Revisión del 18:10 24 ene 2016
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
- 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
- Ears
- Nose
- Oral
- Other face
- Zygomatic arch fracture
- Zygomaticomaxillary (tripod) fracture
- Related
Diagnosis
- 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
- Amoxicillin-clavulanate for uncomplicated
Disposition
- Discharge with 24hr ENT or ED follow-up