Septal Hematoma
A blood collection in the nasal septum that needs prompt treatment
Quick Facts
- Type: Nasal injury complication
- Cause: Trauma to the nose
- Urgency: Needs prompt drainage
- If untreated: Cartilage damage, saddle-nose deformity, infection
Overview
The nasal septum is the wall of cartilage and bone that divides the inside of the nose into two passages. A septal hematoma is a collection of blood that builds up between the septal cartilage and the membrane (mucosa) that covers it, usually after an injury to the nose.
Although it may seem like a minor problem, a septal hematoma is a true urgency. The cartilage of the septum gets its blood supply from the overlying lining; when blood collects and separates them, the cartilage can be starved of nutrients and break down. Prompt recognition and drainage prevent serious complications, so any nose injury followed by worsening blockage or pain should be checked.
Symptoms
A septal hematoma typically follows a nose injury and may cause:
- Nasal blockage or congestion, often in both nostrils and worsening over hours to days
- Nasal pain or pressure
- A visible swelling or bulge inside the nose on the septum
- Difficulty breathing through the nose
- Tenderness over the nose
If infection develops, fever and increasing pain can occur. Because the swelling is inside the nose, it can be missed; a worsening blocked nose after trauma is an important clue to have the nose examined.
Causes
A septal hematoma is almost always caused by trauma to the nose, which tears small blood vessels and allows blood to collect under the lining of the septum. Common scenarios include:
- A direct blow to the nose, such as from sports, falls, fights, or accidents
- A broken nose
- Nasal or facial surgery, occasionally
People with bleeding tendencies or who take blood-thinning medication may be more prone to forming a hematoma after an injury.
Risk Factors
- Recent nose or facial injury
- Contact sports and activities with collision risk
- Bleeding disorders
- Use of blood-thinning medications
- Children, in whom the cartilage is especially vulnerable
Diagnosis
Diagnosis is made by examining the inside of the nose, often after a known injury:
- Nasal examination: A clinician looks inside the nose with a light and speculum and may gently press the swelling, which feels soft and can fluctuate, unlike a simple deviated septum.
- Assessment for a nasal fracture, which often accompanies a hematoma.
- Imaging is not usually needed for the hematoma itself but may be done to assess associated facial injuries.
Because the condition is time-sensitive, any suspected septal hematoma should be evaluated quickly.
Treatment
A septal hematoma needs prompt treatment to relieve pressure and protect the cartilage:
- Drainage: The collected blood is drained by a clinician through a small incision or needle, releasing the pressure on the cartilage.
- Packing or splinting: The nose may be packed or splinted afterward to keep the lining pressed against the cartilage and prevent the blood from re-collecting.
- Antibiotics: Often given to prevent or treat infection.
- Follow-up: Re-examination to make sure the hematoma has not returned and the cartilage is healthy.
- Treating associated injuries, such as a fractured nose.
When drained early, most people recover well. Delay can lead to cartilage loss, a collapsed bridge of the nose (saddle-nose deformity), an abscess, or a hole in the septum.
Prevention
- Wear appropriate protective gear during contact sports
- Take care to prevent falls and facial injuries
- Have any significant nose injury examined, especially if the nose becomes increasingly blocked or painful
- Seek prompt care after nasal trauma rather than waiting
When to See a Doctor
Seek prompt medical care after a nose injury if you notice:
- Worsening blockage of one or both nostrils
- Increasing nasal pain or pressure
- A swelling or bulge inside the nose
- Fever or signs of infection after the injury
A septal hematoma is time-sensitive. Early drainage prevents lasting damage to the cartilage and the shape of the nose, so do not wait to have it checked.
Frequently Asked Questions
Why is a septal hematoma considered an emergency?
Because the septal cartilage gets its blood supply from the overlying lining, a hematoma that separates them can starve the cartilage and cause it to break down within days. Prompt drainage prevents permanent damage, infection, and nose deformity, so it should not be left untreated.
How do I know if I have a septal hematoma after a nose injury?
Suspect it if your nose becomes increasingly blocked, painful, or swollen inside in the hours to days after an injury. The only way to confirm it is for a clinician to look inside the nose, so get it examined promptly after significant nasal trauma.
What happens if a septal hematoma is not treated?
Untreated, it can lead to loss of the septal cartilage, a collapsed nasal bridge (saddle-nose deformity), an abscess, or a hole in the septum. It can also become infected. These complications are largely preventable with early drainage.
How is a septal hematoma treated?
A clinician drains the collected blood through a small incision or needle, then often packs or splints the nose to prevent it from re-collecting. Antibiotics are commonly given, and follow-up ensures it does not return.
Can a child get a septal hematoma?
Yes, and children are especially vulnerable because their nasal cartilage is more easily damaged. Any child with a nose injury followed by worsening nasal blockage or swelling should be examined promptly.
References
- American Academy of Otolaryngology–Head and Neck Surgery.
- MedlinePlus, U.S. National Library of Medicine.
- StatPearls, National Library of Medicine. Nasal septal hematoma.
- Merck Manual. Nasal trauma.