Nasal septal hematoma: Difference between revisions
m (Rossdonaldson1 moved page Septal hematoma to Nasal septal hematoma) |
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*Requires immediate incision and drainage to prevent nasal septum necrosis | *Requires immediate incision and drainage to prevent nasal septum necrosis | ||
**Can lead to saddle nose deformity, nasal septum abscess | **Can lead to saddle nose deformity, nasal septum abscess | ||
*Suspect septum abscess in | *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== | |||
*Adults present with significant facial trauma and nasal fracture | *Adults present with significant facial trauma and nasal fracture | ||
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**Rhinorrhea (25%) | **Rhinorrhea (25%) | ||
**Fever (25%) | **Fever (25%) | ||
==Differential Diagnosis== | |||
==Diagnosis== | |||
*Usually clinical | |||
==Management== | ==Management== | ||
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#Achieve visualization with nasal speculum | #Achieve visualization with nasal speculum | ||
#Make horizontal incision superficially through the mucosa and the perichondrium | #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 | #Evacuate clot with Frazier suction or forceps | ||
#Insert single 1/8in iodoform gauze wick into the incision to avoid premature closure | #Insert single 1/8in iodoform gauze wick into the incision to avoid premature closure | ||
#Perform b/l anterior nasal packing w/ nasal tampons coated w/ topical abx | #Perform b/l anterior nasal packing w/ nasal tampons coated w/ topical abx | ||
# | #*Prevents reaccumulation of clot and keeps septum midline | ||
#Give oral abx (cover S. aureus, H. flu, S. pneumo) | #Give oral abx (cover S. aureus, H. flu, S. pneumo) | ||
##Amoxicillin/clavulanate for uncomplicated | ##Amoxicillin/clavulanate for uncomplicated | ||
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==Disposition== | ==Disposition== | ||
*Discharge | *Discharge with 24hr ENT or ED follow-up | ||
==See Also== | ==See Also== | ||
Revision as of 17:59, 3 December 2015
Background
- Requires immediate incision and drainage to prevent nasal septum necrosis
- Can lead to saddle nose deformity, nasal septum abscess
- 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
- 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
Diagnosis
- Usually clinical
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 b/l anterior nasal packing w/ nasal tampons coated w/ topical abx
- Prevents reaccumulation of clot and keeps septum midline
- Give oral abx (cover S. aureus, H. flu, S. pneumo)
- Amoxicillin/clavulanate for uncomplicated
- Clindamycin if abscess suspected
Disposition
- Discharge with 24hr ENT or ED follow-up