What is Septal Hematoma?
Nose is an extremely tender structure present in the face. This makes it vulnerable to injuries and trauma. In majority of the cases, a nasal injury or trauma does not require any medical intervention. However, there is one complication of nasal trauma or injury that can be potentially serious. This condition is medically referred to as Septal Hematoma. This complication of a nasal injury is quite rare but when it occurs it requires immediate treatment. Septal Hematoma occurs when there is accumulation of blood under the mucoperiosteum of the nasoseptal cartilage. It can occur on side or both the sides of the nose may be involved with the bilateral involvement being more common [1].
An individual can sustain a nasal trauma due to a variety of reasons with the most common reasons being sporting injury or an automobile crash. In some cases, an individual can sustain severe injury to the nose after a brawl or an assault. It should be noted here that it is not necessary for an individual to sustain a major trauma to have Septal Hematoma. Even minor injuries can result in an individual having this condition. This is especially true in the case of small children. In some cases, child abuse is detected by the presence of Septal Hematoma in the absence of any visible injuries [1].
In some cases where an individual has undergone a surgical procedure like a sinus surgery or a nasal turbinate surgery, there may be development of Septal Hematoma. In rare instance an individual may have Septal Hematoma as a result of being on anticoagulants or antiplatelet medications for a long period of time. Coming to the prevalence of this condition, the exact figures are not known but it is believed to occur in about 1% of people who go to an ENT clinic for nasal injuries or trauma [1].
Another fact of the matter is that many cases of Septal Hematoma remain undiagnosed until there are complications. This happens usually in cases of children. A Septal Hematoma can cause significant damage to the tissues of the nose resulting in the structure to look deformed. The patient also complains of severe pain in the nose which is often at times unrelenting. At times, the hematoma may block the flow of the blood to the septal area which leads to tissue and cell necrosis [1].
What Causes Septal Hematoma?
It is often seen that some people develop Septal Hematoma even after a minor injury to the nose while others do not get this condition even after a severe trauma. Why this happens is something that even the researchers are not sure of. However, they are of the belief that a nose trauma or injury impacts the mucous membranes. The trauma also causes the blood vessels to rupture through which blood flows out. In such a scenario if the mucous membranes do not open up then there is accumulation of blood within these membranes causing Septal Hematoma [2].
With regard to risk factors, since a nose trauma and injury is the primary reason why most cases of Septal Hematoma occur, there is no specific risk factor as such. However, there are several risk factors which can result in a severe trauma or injury to the nose. These risk factors include playing contact sports like boxing or wrestling. An individual can also injure the nose after being involved in an automobile crash [2].
Assault or a brawl at home or on the streets is also one of the common risk factors for a blow to the nose big enough to cause a Septal Hematoma. Some people who have had surgical procedures to the nose are also at risk for developing Septal Hematoma [2].
What Are The Symptoms Of Septal Hematoma?
As stated, the primary cause of Septal Hematoma is an injury or trauma to the nose. The symptom onset, however, of this condition is variable and can range from hours to at times weeks after the initial injury. In some cases, even if there is a hematoma after an injury to the nose, the affected individual may perceive it as a result of the injury and not due to hematoma. This makes it extremely important for any individual affected with a nose injury to get checked thoroughly by a professional, especially if the trauma is deemed to be serious. If an individual suffers a broken nose it can also cause a nasal hematoma [2].
In such cases, the individual will experience immediate bleeding after the injury. There will be visible swelling around the nose and the eyes. In some cases after a nasal fracture the bleeding may not be immediate but occurs a few hours after the initial injury. There is continuous drainage from the nose. There will also be obvious nasal deformity due to the fracture [2].
However, for Septal Hematoma the primary symptom is persistent blockage of the nose. The blockage may affect one or both sides of the nose based on where the hematoma has actually formed. On inspection, there may be a visible erythematous mass within the affected nostril. Some people also find it difficult to breathe due to Septal Hematoma. The nose also feels full and blocked always. This happens especially after an injury to the nose. This is the reason why Septal Hematoma needs to be addressed at the soonest possible time [2].
In some cases, due to delays in treatment, the hematoma gets infected. In such instances, the affected individual will have excruciating pain and warmth around the nasal area. Some people also complain of fever as a result of an infected Septal Hematoma [2].
For babies and newborns that develop Septal Hematoma, pain tends to be extremely severe as they breathe through their nose and the friction that the air causes within the nose causes pain. Thus, if a child is crying and cannot be consoled following a nose injury then Septal Hematoma may be one of the causes for it [2].
How Is Septal Hematoma Treated?
With regard to treatment of Septal Hematoma, the blood that has been accumulated needs to be drained out. This is mostly done under local anesthesia and is a same day procedure. The procedure involves making a nick in the nose and then draining the blood out. The physician will then put gauze to stop the blood flow. In cases where the patient is a young child or a baby then the procedure will be done under general anesthesia [2].
Children who do nasal breathing will often at times need a tube to be placed in the nose to allow them to breathe normally till the time the wound heals. An untreated Septal Hematoma may result in potentially serious complications which will require much aggressive medical intervention. An untreated Septal Hematoma makes the affected individual prone to infections. In such cases, the individual may need to be put on a course of antibiotics which will be either orally or through IV [2].
Drainage may also be required to treat the swelling around the infection site to remove the necrosed cells and tissues. Deviated septum is yet another complication of untreated Septal Hematoma. An individual with a deviated septum will be prone to various sinus infections and also will have problems with breathing normally. A deviated septum almost always requires surgery to correct the deformity. However, it is not always that a surgery for the deviated septum will make the shape of the nose look normal [2].
In cases where large chunks of tissues and cells get damaged due to Septal Hematoma, then physicians may use a graft to replace the damaged tissues with tissues taken from other parts of the body. Once Septal Hematoma is drained there may be pain and swelling in the nose for a few days for which the patient will be given pain medications in the form of ibuprofen or Tylenol [2].
Ice packs on the nose will also be recommended for 15-20 minutes two to three times every day till the pain and swelling resolves. A physician needs to be consulted in cases where the pain does not resolve or gets worse [2].
In conclusion, Septal Hematoma is a rare complication of a nasal trauma or injury. It occurs when blood pools within the mucous membranes. This happens when a trauma breaks open the blood vessels and the mucous membranes remain closed not allowing the blood to flow out resulting in the development of a hematoma. Septal Hematoma is a treatable condition and requires drainage of the blood for which an incision will be made in the nose. This is normally done under local anesthesia but in cases of small children and babies it is done under general anesthesia [1, 2].
If Septal Hematoma is left untreated, then it may lead to a variety of complications some of which are potentially serious. An untreated Septal Hematoma may make the individual prone to variety of infections. In some cases, it may also cause the individual to have a deviated septum. This condition requires surgery to correct the deformity. Post treatment, there will be pain and swelling around the nose which will be treated with medications and ice packs for about a week till the wound clears up [2].
However, if the pain and swelling does not resolve and becomes worse it is recommended to consult with a physician to rule out any infection and formulate a different treatment plan for Septal Hematoma. Thus it is advised that whenever there is a nose injury or trauma due to any reason then it is better to get that checked up with an ENT physician to prevent any chances of an undiagnosed Septal Hematoma [2].
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