How do you drain a septal hematoma?

Reviewed on 1/13/2021

The nose is the most commonly injured structure in injuries involving the face.
The nose is the most commonly injured structure in injuries involving the face.

The nose is divided into left and right nostrils by a wall of fibrous tissue and cartilage called the septum. The septum has a rich blood supply and can therefore bleed profusely when injured. A septal hematoma refers to a collection of blood within the septum due to blunt trauma. A hematoma or collection of blood may occur anywhere in the body. It generally gets absorbed on its own with time. A septal hematoma, however, needs to be drained by the doctor. If not drained, a septal hematoma can cause serious complications such as infections, nasal perforation (formation of holes in the nasal septum), abscess formation (collection of pus), and deformities of the nose (crooked or saddle-shaped nose).

Causes of a septal hematoma may include:

  • Fracture involving the nose due to a blow
  • Soft tissue injuries involving the nose, especially during sports
  • Bleeding disorders
  • Blood-thinning medications
  • Surgeries involving the nose

What are the symptoms of a septal hematoma?

A septal hematoma may present with the following symptoms:

  • Swelling between the two nostrils (involving the septum)
  • Pain
  • Difficulty in breathing
  • Change in the size or shape of the nose
  • Stuffiness or nasal congestion
  • Fever (if there is associated infection)

How do you drain a septal hematoma?

A septal hematoma must be urgently drained to avoid the development of complications. The doctor will generally diagnose a septal hematoma based on the patient’s medical history and physical examination. They may order tests such as computed tomography (CT) scan or magnetic resonance imaging (MRI) in cases where the diagnosis is not confirmed by examination.

Drainage of a septal hematoma is done by the doctor under local anesthesia. In children and apprehensive adults, the doctor may use general anesthesia (the patient sleeps during the procedure) for draining a septal hematoma.

During the procedure:

  • The patient lies on the bed/operating table with their face upward.
  • The head end of the bed/operating table is slightly raised. This allows the blood and other secretions to drain out from the septum easily.
  • The doctor cleans the nasal area with antiseptics.
  • They administer local/general anesthesia.
  • The doctor uses a thin needle (18-20 gauge) to drain a small hematoma.
  • If the hematoma is large, the doctor gives a small incision (surgical cut) over the softest part of the hematoma.
  • The doctor uses suction to remove the clots from the nasal septum.
  • The septum is then irrigated with a saline solution using a thin tube called a catheter.
  • A small tubular structure called a drain is placed in the opened hematoma site and secured with sutures (stitches).
  • The doctor then packs the nose with a sterile bandage doused in antibiotic ointment to prevent the re-accumulation of the blood.

After the procedure:

  • Antibiotics and pain medications are administered.
  • The nasal packing is kept as such and removed only when there is no further drainage for at least 24 hours.
  • The patient may be asked to keep the head end of the bed elevated while lying down.

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References
https://emedicine.medscape.com/article/149280-overview

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