QuestionSBA
QuestionChoice
This is the correct course of action. Septal haematomas must be evacuated to preserve blood supply to the nasal cartilage, as the septal cartilage relies on nutrient and oxygen delivery from the perichondrium. Untreated, the septum may collapse, causing a saddle-nose deformity.
10017286
a
Refer to ENT for incision and drainage under general anaesthetic
QuestionChoice
This is not appropriate - a septal haematoma is an emergency requiring intervention to prevent damage to the nasal septal cartilage.
10017287
b
Reassurance and discharge
QuestionChoice
ENT referral is required, however needle aspiration is likely to be insufficient to drain the haematoma, which is required to ensure that the nasal septum continues receiving oxygen and nutrients.
10017290
e
Refer to ENT for antibiotics and needle aspiration
QuestionChoice
This is the correct management for epistaxis, not for a septal haematoma.
10017288
c
Cauterisation and packing
QuestionChoice
This will not resolve the septal haematoma, and will delay urgent intervention.
10017289
d
Give topical corticosteroids and refer to ENT
QuestionComment
septal haematomas also need Abx cover to prevent serious infections.
44718
User
subscriber
Probably Sepsis
QuestionComment
ENTUK state that septal haematomas can be drained under local in older children and adults. 
45987
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subscriber
Womb Syndrome
Concept
Chapter
# Summary

Septal haematoma is a medical condition caused by bleeding under the perichondrium lining of the septal cartilage, typically due to nasal trauma. Key signs and symptoms include bilateral cherry-red swelling arising from the nasal septum, discernible through anterior rhinoscopy. Immediate referral to an ENT specialist for emergency incision and drainage is critical to prevent life-threatening infections and severe cosmetic nasal deformities.

# Definition

Septal haematoma is a condition characterized by an accumulation of blood in the septal space due to bleeding under the perichondrium lining the septal cartilage. This is often a consequence of nasal trauma.


# Aetiology

The primary cause of septal haematoma is bleeding under the perichondrium lining the septal cartilage, typically resulting from nasal trauma. The septal cartilage, which receives blood supply from the overlying mucosa, can be disrupted by the haematoma. If untreated, this damage can progress to irreversible septal perforation and necrosis within 24 hours, culminating in a saddle-nose deformity.

# Signs and symptoms

The primary sign of a septal haematoma is a bilateral cherry-red swelling visible on the nasal septum. 

This condition must be suspected and investigated whenever nasal trauma has occurred.

# Differential diagnosis

Include:
- Nasal fracture
- Nasal abscess
- Foreign body in the nose. 

Each of these conditions can present with similar symptoms such as nasal obstruction, pain, and swelling. However, they differ in their presentation and management.

# Investigations

Anterior rhinoscopy is the primary tool for investigating suspected septal haematoma. It reveals a bilateral **cherry-red swelling** arising from the nasal septum. It is critical to inspect the nasal septum following any nasal trauma.

# Management

Prompt referral to an Ear, Nose, and Throat (ENT) specialist for emergency incision and drainage is the standard management strategy for septal haematomas. 

This intervention is essential for preventing life-threatening infectious complications and severe cosmetic nasal deformities.

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Nasal trauma
Topic
24
Ear, Nose & Throat
16001
Bilateral nasal swelling after trauma may indicate a septal haematoma, requiring urgent drainage to prevent complications such as saddle-nose deformity.
A 15-year-old boy comes to the ED after getting hit in the face by the ball.  On inspection of the nose, a bilateral red swelling can be observed.

Given the likely diagnosis, which of the following is the definitive management plan?
a