Hematoma under the septal cartilage membrane or bone membrane forms a nasal septal hematoma, which is the result of traumatic injury to the nasal septum. Spontaneous hematomas are rare.

bubble_chart Etiology

Traumatic injury of the nose can cause a fracture of the nasal septum, leading to blood vessel rupture while the mucous membrane remains intact, resulting in a hematoma. Hematoma can also occur as a complication of submucous resection of the nasal septum.

bubble_chart Clinical Manifestations

Hematomas are usually bilateral, resulting in persistent bilateral stuffy nose that does not improve with nasal drops of Ephedrine. Patients often experience frontal headaches and a sense of pressure on the nasal bridge, which feels soft to the touch.

bubble_chart Diagnosis

The diagnosis can be easily made based on clinical manifestations and signs. If the hematoma is located in the posterior region and there is swelling of the anterior mucous membrane or the presence of blood clots, the hematoma may often be difficult to detect. In such cases, nasal secretions or blood clots should be removed, and a thorough examination of the posterior nasal septum should be performed using a nasal endoscope.

bubble_chart Treatment Measures

Hematomas generally do not easily resolve with anti-inflammatory treatment and require early aspiration or incision and drainage to prevent cartilage necrosis or secondary infection leading to abscess formation. Small hematomas can be aspirated. For larger hematomas, after surface anesthesia of the mucosa, a parallel incision to the nasal floor should be made beneath the hematoma. The incision should be sufficiently large to thoroughly remove the coagulated blood beneath the soft tissue. If the hematoma occurs secondary to submucosal resection of the nasal septum, the original incision can be reopened to separate the soft tissues on both sides, ensuring complete removal of static blood or clots. After hematoma evacuation, both nasal cavities must be tightly packed with sterile petrolatum gauze to prevent rebleeding. Timely administration of antibiotics is also essential.