Nasal septal hematoma | |
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Other names | Nasal septal hematoma |
Nasal septal hematoma | |
Specialty | Otolaryngology |
Nasal septal hematoma is a condition affecting the nasal septum. [1] It can be associated with trauma. [2]
A septal hematoma is blood that collects in the space between the septal cartilage and the overlying perichondrium (a cross section of the cartilaginous portion of the nasal septum). A hematoma may deprive the septal cartilage of its blood supply from the overlying mucosa and can lead to permanent sequelae. [3]
The septal cartilage has no blood supply of its own and receives all of its nutrients and oxygen from the perichondrium. An untreated septal hematoma may lead to the destruction of the septum and immediate drainage is necessary. Untimely diagnosis and/or treatment of septal hematomas can cause what is called a saddle nose deformity. [4]
This condition is more common in children because the septum is thicker and the lining more flexible. [5]
A normal nasal septum is rigid and thin. If you have a septal hematoma, your doctor will be able to press it down with a swab as the area will be soft. A quick check in the nose will show any swelling between the nostrils.
Symptoms can include:
On occasion, it is possible for people with a septal hematoma to experience headache, nausea, vomiting, and fainting.[ medical citation needed ]
The most common causes of nasal septal hematomas include:
In adults, nasal septal hematoma typically occur with significant facial trauma and/or nasal fracture. [6] However, in children, due to their thicker septum and more flexible lining, nasal septal hematoma can be caused from minor nasal trauma such as simple falls, collisions with stationary objects, or minor altercations with siblings. [6]
The exact mechanism for the formation of hematoma from nasal trauma is controversial, but thought to occur in nasal septal hematomas when there is forced to the nasal cartilage. The force causes the perichondrial blood vessels to leak and rupture in the nasal septum. [7] The cartilage in the septum is avascular and can be 2–4 mm thick. The septum gets its blood supply from the ethmoid and sphenopalatine arteries. [4]
The nasal septum is composed of cartilaginous, membranous, and bony components overlaid by mucoperichondrium and mucoperiosteum. Bleeding within the confines of the mucoperichnondrium leads to a septal hematoma, where as external bleeding from Kiesselbach's plexus results in epistaxis. [3] The Kiesselbach plexus is located anterior inferior of the nasal septum, where the anastomosis of blood vessels is located. [4]
Normal nasal mucosa is pink and healthy appearing, without ulcerations, crusting, or bleeding. Some common, abnormal variations include septal deviations, spurs, and an enlarged, aerated middle turbinate. Pale or inflamed mucosa, purulence, nasal polyps, or a septal perforation are all common pathologic features that may or may not be combined with the abnormal variations listed above. [3]
The doctor will use a nasal speculum for visualization of the nasal septum, the inferior turbinate, and a portion of the middle turbinate. The view of the nasal passage may be partially obstructed by the tools used. When there is minimal obstruction, it is often possible to visualize the nasopharynx. [3]
Identifying the Nasal Septal Hematoma
If lateral bulging of the septum and fluctuance persist after the nasal administration of a vasoconstrictive agent, such as oxymetazoline, it is a strong indicator of a nasal septal hematoma. A septal hematoma is highly likely in patients who have had trauma or a sudden onset of nasal blockage that does not resolve with the removal of blood clots and the administration of a vasoconstrictive agent. [3]
Diagnosis can be made by a medical professional after performing an anterior rhinoscopy examination, by using an otoscope or a nasal speculum and overhead light source. [3]
A septal hematoma requires urgent treatment from a physician in order to stop any further complications arising.
Prompt treatment of septal hematomas can prevent complications such as ischemia of the septal cartilage, which can lead to permanent necrosis and a saddle-nose deformity. Such complication can occur rapidly, within as few as 3 days. [3]
There are two different procedures used to achieve this and will be selected upon the size of the swelling or clot. If the condition is being treated promptly and is still relatively small, then a small incision can be made to allow the blood to flow out. If left untreated, the hematoma can cause bacterial colonization that leads to infection. Within 72 hours, the infection can form a septal abscess. [4]
Treating a septal hematoma requires it to be incised and drained to prevent avascular necrosis of the septal hyaline cartilage. This will depend on diffusion of nutrients from its attached nasal mucosa. [8]
The septum can generally heal within 1 week, without any evidence of the incision. The mucosa will appear healthy and smooth. [3]
Secondary infections can be prevented by starting the patient on an antibiotic regimen immediately after the procedure and continuing the treatment while the nasal packs are in place. If an abscess is present, a specimen of the abscess can be sent for culture to ensure that the antibiotics prescribed have provided adequate coverage. Culture-directed therapy can help avert dangerous late sequalae, including the intracranial extension of a septal abscess. If the hematoma is not promptly drained, the septal cartilage may be destroyed. In such cases, a saddle-nose deformity may develop. [3]
As long as the septal hematoma is treated promptly, a full recovery is common. If the condition is left untreated and develops complications such as fever, infection, or an abscess, then the nasal septal hematoma is still treatable if seen by a physician.
Septal hematomas are rare but can effect everyone in every age group. There is no exact number of the incidence that occur because a lot of the cases will remain undiagnosed. Although, patients that have visited an ear, nose and throat clinic for nasal septal hematomas, reported to be in between 0.8% to 1.6% of patients. [4] 65.6% of nasal septal hematoma cases in Nigeria had unknown cause, where 30.4% were caused by trauma. [9]
Within 10 years at the University of Nigeria Teaching Hospital, there was a total of 53 patients that ranged from 5 to 65 years of age. Consisted of 37 males and 16 females. The highest age group with nasal septal hematoma was 10–18 years of age followed by 1–9 years of age. [10]
The research article went into detail about a 9-month-old going to get medical attention after an incident that happened a week prior. The child had swelling in both sides of the septum, with no history of nose bleeds. Under the general anesthesia, a nasal drain was done by a 4mm endotracheal tube. The article explained how this procedure done by medical professionals, was a new innovative way to treat the child. The research article came into conclusion that all cases of nasal septal hematoma need immediate attention to prevent from having complications and deformities. The endotracheal tube is another alternative for the nasal pack and allowed the child to be at comfort in the postoperative period. [9]
Based on a different study from patients who were treated at the University of Nigeria Teaching Hospital in Enugu Nigeria. This all occurred within a 10-year period, 53 patients were successfully treated by incision and drainage. [10]
An abscess is a collection of pus that has built up within the tissue of the body. Signs and symptoms of abscesses include redness, pain, warmth, and swelling. The swelling may feel fluid-filled when pressed. The area of redness often extends beyond the swelling. Carbuncles and boils are types of abscess that often involve hair follicles, with carbuncles being larger. A cyst is related to an abscess, but it contains a material other than pus, and a cyst has a clearly defined wall. Abscesses can also form internally on internal organs and after surgery.
Rhinoplasty, commonly called nose job, medically called nasal reconstruction, is a plastic surgery procedure for altering and reconstructing the nose. There are two types of plastic surgery used – reconstructive surgery that restores the form and functions of the nose and cosmetic surgery that changes the appearance of the nose. Reconstructive surgery seeks to resolve nasal injuries caused by various traumas including blunt, and penetrating trauma and trauma caused by blast injury. Reconstructive surgery can also treat birth defects, breathing problems, and failed primary rhinoplasties. Rhinoplasty may remove a bump, narrow nostril width, change the angle between the nose and the mouth, or address injuries, birth defects, or other problems that affect breathing, such as a deviated nasal septum or a sinus condition. Surgery only on the septum is called a septoplasty.
The nasal cavity is a large, air-filled space above and behind the nose in the middle of the face. The nasal septum divides the cavity into two cavities, also known as fossae. Each cavity is the continuation of one of the two nostrils. The nasal cavity is the uppermost part of the respiratory system and provides the nasal passage for inhaled air from the nostrils to the nasopharynx and rest of the respiratory tract.
A nosebleed, also known as epistaxis, is an instance of bleeding from the nose. Blood can flow down into the stomach, and cause nausea and vomiting. In more severe cases, blood may come out of both nostrils. Rarely, bleeding may be so significant that low blood pressure occurs. Blood may also be forced to flow up and through the nasolacrimal duct and out of the eye, producing bloody tears.
Septoplasty, or alternatively submucous septal resection and septal reconstruction, is a corrective surgical procedure done to straighten a deviated nasal septum – the nasal septum being the partition between the two nasal cavities. Ideally, the septum should run down the center of the nose. When it deviates into one of the cavities, it narrows that cavity and impedes airflow. Deviated nasal septum or “crooked” internal nose can occur at childbirth or as the result of an injury or other trauma. If the wall that functions as a separator of both sides of the nose is tilted towards one side at a degree greater than 50%, it might cause difficulty breathing. Often the inferior turbinate on the opposite side enlarges, which is termed compensatory hypertrophy. Deviations of the septum can lead to nasal obstruction. Most surgeries are completed in 60 minutes or less, while the recovery time could be up to several weeks. Put simply, septoplasty is a surgery that helps repair the passageways in the nose making it easier to breathe. This surgery is usually performed on patients with a deviated septum, recurrent rhinitis, or sinus issues.
The nasal septum separates the left and right airways of the nasal cavity, dividing the two nostrils.
Cauliflower ear is an irreversible condition that occurs when the external portion of the ear is hit and develops a blood clot or other collection of fluid under the perichondrium. This separates the cartilage from the overlying perichondrium that supplies its nutrients, causing it to die and resulting in the formation of fibrous tissue in the overlying skin. As a result, the outer ear becomes permanently swollen and deformed, resembling a cauliflower, hence the name.
Otoplasty is a procedure for correcting the deformities and defects of the auricle, whether these defects are congenital conditions or caused by trauma. Otoplastic surgeons may reshape, move, or augment the cartilaginous support framework of the auricle to correct these defects.
Nasal septum deviation is a physical disorder of the nose, involving a displacement of the nasal septum. Some displacement is common, affecting 80% of people, mostly without their knowledge.
A nasal septum perforation is a medical condition in which the nasal septum, the bony/cartilaginous wall dividing the nasal cavities, develops a hole or fissure.
Ear pain, also known as earache or otalgia, is pain in the ear. Primary ear pain is pain that originates from the ear. Secondary ear pain is a type of referred pain, meaning that the source of the pain differs from the location where the pain is felt.
Empty nose syndrome (ENS) is a clinical syndrome, the hallmark symptom of which is a sensation of suffocation despite a clear airway. This syndrome is often referred to as a form of secondary atrophic rhinitis. ENS is a potential complication of nasal turbinate surgery or injury. Patients have usually undergone a turbinectomy or other surgical procedures that injure the nasal turbinates.
Chronic atrophic rhinitis, or simply atrophic rhinitis, is a chronic inflammation of the nose characterised by atrophy of nasal mucosa, including the glands, turbinate bones and the nerve elements supplying the nose. Chronic atrophic rhinitis may be primary and secondary. Special forms of chronic atrophic rhinitis are rhinitis sicca anterior and ozaena. It can also be described as the empty nose syndrome.
The nasal cartilages are structures within the nose that provide form and support to the nasal cavity. The nasal cartilages are made up of a flexible material called hyaline cartilage in the distal portion of the nose. There are five individual cartilages that make up the nasal cavity: septal nasal cartilage, lateral nasal cartilage, major alar cartilage, minor alar cartilage, and vomeronasal cartilage.
The human nose is the first organ of the respiratory system. It is also the principal organ in the olfactory system. The shape of the nose is determined by the nasal bones and the nasal cartilages, including the nasal septum, which separates the nostrils and divides the nasal cavity into two.
Mouth infections, also known as oral infections, are a group of infections that occur around the oral cavity. They include dental infection, dental abscess, and Ludwig's angina. Mouth infections typically originate from dental caries at the root of molars and premolars that spread to adjacent structures. In otherwise healthy patients, removing the offending tooth to allow drainage will usually resolve the infection. In cases that spread to adjacent structures or in immunocompromised patients, surgical drainage and systemic antibiotics may be required in addition to tooth extraction. Since bacteria that normally reside in the oral cavity cause mouth infections, proper dental hygiene can prevent most cases of infection. As such, mouth infections are more common in populations with poor access to dental care or populations with health-related behaviors that damage one's teeth and oral mucosa. This is a common problem, representing nearly 36% of all encounters within the emergency department related to dental conditions.
A nasal fracture, commonly referred to as a broken nose, is a fracture of one of the bones of the nose. Symptoms may include bleeding, swelling, bruising, and an inability to breathe through the nose. They may be complicated by other facial fractures or a septal hematoma.
Nasal septal abscess is a condition of the nasal septum in which there is a collection of pus between the mucoperichondrium and septal cartilage.
Nonallergic rhinitis is rhinitis—inflammation of the inner part of the nose—not caused by an allergy. Nonallergic rhinitis displays symptoms including chronic sneezing or having a congested, drippy nose, without an identified allergic reaction with allergy testing being normal. Other common terms for nonallergic rhinitis are vasomotor rhinitis and perennial rhinitis. The prevalence of nonallergic rhinitis in otolaryngology is 40%. Allergic rhinitis is more common than nonallergic rhinitis; however, both conditions have similar presentation, manifestation and treatment. Nasal itching and paroxysmal sneezing are usually associated with nonallergic rhinitis rather than allergic rhinitis. Other symptoms that are more specific to non-allergic rhinitis include ear plugging or discomfort with eustachian tube dysfunction, headaches, sinus pressure, and muffled hearing. Common triggers for non-allergic rhinitis include irritants such as tobacco smoke, cleaning agents, or abrupt changes in ambient temperature.
Nasal surgery is a medical procedure designed to treat various conditions that cause nasal blockages in the upper respiratory tract, for example nasal polyps, inferior turbinate hypertrophy, and chronic rhinosinusitis. It encompasses several types of techniques, including rhinoplasty, septoplasty, sinus surgery, and turbinoplasty, each with its respective postoperative treatments. Furthermore, nasal surgery is also conducted for cosmetic purposes. While there are potential risks and complications associated, the advancement of medical instruments and enhanced surgical skills have helped mitigate them.
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