Daily Bolus of LR: Septal Hematoma

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July 13, 2011 by dailybolusoflr

Septal Hematoma

* Is a rare complication of blunt trauma to the nose
* Is a collection of blood between the perichondrium and the septum
* Needs to be drained as stagnant blood can lead to infection, as well as pressure necrosis to the septum
* Is diagnosed by visual inspection of the nares – asymmetry or a blue/red hematoma is noted
* It is essential to obtain good visualization of the nasal cavity – this is best performed using a nasal speculum, which should be inserted and opened with the blades opening in the up/down direction (this limits pressure on the septum and other delicate structures. The proper technique can be seen here http://www.acep.org/content.aspx?id=45859
* Proper drainage technique involves incising the hematoma, draining with a small tip suction device, +/- placement of a Penrose drain and packing of the anterior nasal cavity to prevent re-accumulation
* A decent schematic exists in the following paper http://www.aafp.org/afp/2004/1001/p1315.html

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