Nasal Septal Hematoma: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
(Created page with "__NOTOC__ {{SI}} {{CMG}}; {{AE}} {{SK}} ==Special consideration when adding information from observational studies== {| class="wikitable" |+ !Template Sentence for Observa...")
 
 
(40 intermediate revisions by the same user not shown)
Line 4: Line 4:
{{CMG}}; {{AE}}
{{CMG}}; {{AE}}


{{SK}}  
{{SK}}
==Overview==
 
==Historical Perspective==
==Classification==
There is no established system for the classification of nasal septal hematoma. 


==Special consideration when adding information from observational studies==
{| class="wikitable"
{| class="wikitable"
|+
|+
!Template Sentence for Observational Study
!
! colspan="4" |Classification of heamatoma
|-
|-
|“Among (number of/other important demographic information) patients in (location), (exposure) was associated with (outcome) in observational data” (REF)
|
|
|
|
|
|-
|-
|Example:
|
 
|Type 1
* Among '''459 adult male diabetic''' patients in the '''United States''', '''COVID-19''' exposure was associated with '''abdominal pain''' in observational data (REF)
|
|
|
|-
|
|Type 2
|
|
|
|-
| rowspan="2" |Type C
|Type Ca
|
|
|
|-
|Type Cb
|
|
|
|}
|}
==Overview==
==Historical Perspective==
[Disease name] was first discovered by [name of scientist], a [nationality + occupation], in [year]/during/following [event].
The association between [important risk factor/cause] and [disease name] was made in/during [year/event].
In [year], [scientist] was the first to discover the association between [risk factor] and the development of [disease name].
In [year], [gene] mutations were first implicated in the pathogenesis of [disease name].
There have been several outbreaks of [disease name], including -----.
In [year], [diagnostic test/therapy] was developed by [scientist] to treat/diagnose [disease name].
==Classification==
There is no established system for the classification of [disease name].
OR
[Disease name] may be classified according to [classification method] into [number] subtypes/groups: [group1], [group2], [group3], and [group4].
OR
[Disease name] may be classified into [large number > 6] subtypes based on [classification method 1], [classification method 2], and [classification method 3].
[Disease name] may be classified into several subtypes based on [classification method 1], [classification method 2], and [classification method 3].
OR
Based on the duration of symptoms, [disease name] may be classified as either acute or chronic.
OR
If the staging system involves specific and characteristic findings and features:
According to the [staging system + reference], there are [number] stages of [malignancy name] based on the [finding1], [finding2], and [finding3]. Each stage is assigned a [letter/number1] and a [letter/number2] that designate the [feature1] and [feature2].
OR
The staging of [malignancy name] is based on the [staging system].
OR
There is no established system for the staging of [malignancy name].


==Pathophysiology==
==Pathophysiology==
The exact pathogenesis of [disease name] is not fully understood.


OR
===Anatomy===


It is thought that [disease name] is the result of / is mediated by / is produced by / is caused by either [hypothesis 1], [hypothesis 2], or [hypothesis 3].
*The nasal septum is made up of a cartilage along with thin layer of [[mucosa]] and [[perichondrium]].
*The nasal septum derives its blood supply from the [[Anterior ethmoidal artery|anterior]] and [[Posterior ethmoidal artery|posterior ethmoid arteries]] and the [[sphenopalatine artery]].


OR
*All these blood vessels form an anastomosis known as Kiesselbach plexus which is found in the anterior inferior third of the nasal septum.


[Pathogen name] is usually transmitted via the [transmission route] route to the human host.
===Pathogenesis===


OR
*When the nasal cartilage is [[Fracture|fractured]], [[blood]] can dissect and form [[hematoma]], which may be bilateral.
*The exact pathogenesis of development of hematoma is not fully understood.
*Though septal cartilage is an avascular structure, it gets nourished from the overlying [[perichondrium]].
*Any trauma to nasal septum disrupts the blood supply to the perichondrium due to external force that pull the closely adherent mucoperichondrium from the underlying cartilage.
*Hematoma sets in the vacant space due to the rupture of submucosal vessels.
*Further expansion of the hematoma exerts pressure induced ischemic changes on the cartilage.
*If not rapidly evacuated, pressure-induced ischemic changes leads to avascular necrosis of the nasal cartilage ultimately into perforation
*The accumulated blood and necrotic tissue also form a nidus for infection with bacteria that colonize the nasal mucosa.
*Once necrosis and/or septal abscess occur, the replacement of necrotic tissue by fibrous tissue, retraction of scar tissue, and loss of support to the lower nose may lead to facial deformity, including saddle nose, displacement of the maxilla, retraction of the anterior nasal septum (columella), widening of the nasal base, and diminished size of the nasal cavity
*This causes the rupture of submucosal vessels which ultimately causes a collection of blood between the cartilage and the perichondrium.
*Hematoma thus formed, results in pressure-related ischaemic changes and the subsequent necrosis of the septal cartilage.
*If the trauma is severe enough, the septal cartilage gets fractured, and blood sweeps to the opposite side resulting in a bilateral septal hematoma.
*This situation is more hazardous as it doubles the compromise on the nutrient supply of septal cartilage and hastens the process of cartilage necrosis.


Following transmission/ingestion, the [pathogen] uses the [entry site] to invade the [cell name] cell.
*Hematoma acts as an ideal medium for bacterial proliferation and colonization.
 
*
OR
 
 
[Disease or malignancy name] arises from [cell name]s, which are [cell type] cells that are normally involved in [function of cells].
 
OR
 
The progression to [disease name] usually involves the [molecular pathway].
 
OR
 
The pathophysiology of [disease/malignancy] depends on the histological subtype.


==Causes==
==Causes==
Disease name] may be caused by [cause1], [cause2], or [cause3].


OR
*The most common cause of nasal septal hematoma is nasal trauma.
**Nasal trauma can be secondary to sports injuries, road-side accidents, falls, assault or occupational injuries.
**Even a minor injury can lead to nasal septal hematoma, especially in children.


Common causes of [disease] include [cause1], [cause2], and [cause3].
*Nasal septal hematoma without history of injury must look into  the suspicion of child abuse.


OR
*Iatrogenic septal hematoma may arise as a complication of nasal surgeries.
*Atraumatic septal hematoma is rarely seen in patients with bleeding diathesis or as an adverse effect of antiplatelet/anticoagulant drugs.


The most common cause of [disease name] is [cause 1]. Less common causes of [disease name] include [cause 2], [cause 3], and [cause 4].
==Differentiating Nasal Septal Hematoma from other Diseases==
Nasal septal hematoma must be differentiated from other diseases with similar presentation


OR
*[[Angiofibroma]]


The cause of [disease name] has not been identified. To review risk factors for the development of [disease name], click [[Pericarditis causes#Overview|here]].
*[[Adenoid hypertrophy]]


==Differentiating ((Page name)) from other Diseases==
*[[Chronic sinusitis]]
[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].


OR
*[[Chondromas]]


[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].
*[[Hemangioma]]


==Epidemiology and Demographics==
*[[Malignancies]]
The incidence/prevalence of [disease name] is approximately [number range] per 100,000 individuals worldwide.


OR
*[[Nasal polyps]]


In [year], the incidence/prevalence of [disease name] was estimated to be [number range] cases per 100,000 individuals worldwide.
*[[Papillomas]]


OR
*[[Granulomas|Pyogenic granulomas]]


In [year], the incidence of [disease name] is approximately [number range] per 100,000 individuals with a case-fatality rate of [number range]%.
*[[Rhinitis]]


*[[Abscess|Septal abscess]]


*[[Deformities|Septal deformities]]


Patients of all age groups may develop [disease name].


OR
==Screening==


The incidence of [disease name] increases with age; the median age at diagnosis is [#] years.
==Epidemiology and Demographics==


OR
*The exact incidence of nasal septal hematoma is unknown as majority of the cases are undiagnosed.
 
*However, from the reported cases of nasal injuries incidence of septal hematoma was 0.8% to 1.6%.
[Disease name] commonly affects individuals younger than/older than [number of years] years of age.
 
OR
 
[Chronic disease name] is usually first diagnosed among [age group].
 
OR
 
[Acute disease name] commonly affects [age group].
 
 
 
There is no racial predilection to [disease name].
 
OR
 
[Disease name] usually affects individuals of the [race 1] race. [Race 2] individuals are less likely to develop [disease name].
 
 
 
[Disease name] affects men and women equally.
 
OR
 
[Gender 1] are more commonly affected by [disease name] than [gender 2]. The [gender 1] to [gender 2] ratio is approximately [number > 1] to 1.
 
 
 
The majority of [disease name] cases are reported in [geographical region].
 
OR
 
[Disease name] is a common/rare disease that tends to affect [patient population 1] and [patient population 2].


==Risk Factors==
==Risk Factors==
There are no established risk factors for [disease name].


OR
*The most potent risk factor in the development of nasal septal hematoma is injury to the nose.
 
*Risk factors for nose injury include:
The most potent risk factor in the development of [disease name] is [risk factor 1]. Other risk factors include [risk factor 2], [risk factor 3], and [risk factor 4].
**Contact sports
 
**Motor vehicle accident (MVA)
OR
**Recental nasal surgery
 
**Nasal fracture
Common risk factors in the development of [disease name] include [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].
 
OR
 
Common risk factors in the development of [disease name] may be occupational, environmental, genetic, and viral.


==Screening==
==Screening==
There is insufficient evidence to recommend routine screening for [disease/malignancy].
The [a'dajfa'g 


OR
=== When to screen ===


According to the [guideline name], screening for [disease name] is not recommended.
* WHen the patoient comes with bleeding
* WHen they invokve in fight
*


OR
==Natural History, Complications, and Prognosis==


According to the [guideline name], screening for [disease name] by [test 1] is recommended every [duration] among patients with [condition 1], [condition 2], and [condition 3].
====Natural History====


==Natural History, Complications, and Prognosis==
*If left untreated, the infection can spread to the nearby anatomical structures like paranasal sinuses, orbit or intracranial structures, through the venous draining the mid-face.
If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].


OR
*Avascular necrosis and secondary infection can lead to the collapse of septal cartilage causing various types of nasal deformities.  
*In children, destruction can cause an altered growth of mid-face and permanent facial deformity.


Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
====Complications====


OR


Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.
Common complications associated with untreated septal hematoma include:
{| class="wikitable"
|+
!
!
|-
|Local
|
*Septal abscess
*Saddle nose
*Deviated nasal septum
*Nasal valve collapse
*Sinusitis
*Facial cellulitis
*Nasal vestibulitis
|-
|Systemic
|
*Sepsis
*Bacteremia
|-
|Orbital
|
*Orbital cellulitis
*Sub-periosteal abscess
*Orbital abscess
|-
|Intracranial Complications
|
*Cavernous sinus thrombosis
*Epidural abscess
*Meningitis
|}
<br />Prognosis


If hematoma is not evacuated early, it may lead to irreversible damage as soon as 24 hours after injury.
==Diagnosis==
==Diagnosis==
===Diagnostic Study of Choice===
===Diagnostic Study of Choice===
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
Nasal septal hematoma is a clinical diagnosis. The diagnosis of septal hematoma can be established by taking a careful history and performing complete physical examination.
 
OR
 
The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
 
OR
 
The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
 
OR
 
There are no established criteria for the diagnosis of [disease name].


===History and Symptoms===
===History and Symptoms===
The majority of patients with [disease name] are asymptomatic.
The majority of patients with nasal septal hematoma presents within  within the first 24 to 72 hours after trauma. The most common symptom are


OR
*Nasal obstruction ( unilateral or bilateral)
 
*Pain
The hallmark of [disease name] is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3]. Common symptoms of [disease] include [symptom 1], [symptom 2], and [symptom 3]. Less common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].
*Rhinorrhea
*Fever
*Nasal deformity /Nasal pain


===Physical Examination===
===Physical Examination===
Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
Clinical examination of nasal septal hematoma is usually confirmatory. Findings on nasal speculum or otoscope include


OR
*Blood clots
*Asymmetry of the septum with bluish or reddish mucosal swelling suggests a hematoma.
*On direct palpation by inserting the little finger feels soft and fluctuant in contrast to deviated nasal septum which will be firm and concave on the opposite side.
*Lack of reduction in size on the application of vasoconstrictive agents.


Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].
{| class="wikitable"
|+
!Examination
!Physical Findings
|-
|Inspection
|Identifies location and extent of nasal injury


OR
*Epistaxis, edema, and ecchymosis suggest septal injury
|-
|Palpation
|Tenderness over the tip of nose is specific for septal hematoma
|-
|Examination of the nasal cavity
|Findings suggestive of septal hematoma include:


The presence of [finding(s)] on physical examination is diagnostic of [disease name].
*Asymmetry of the septum
*Blue or red discoloration of the nasal septum
*Nasal mucosal swelling obstructing the nasal passage
*Lack of reduction in size on the application of vasoconstrictive agents.
**
**


OR
*


The presence of [finding(s)] on physical examination is highly suggestive of [disease name].
*
|}


===Laboratory Findings===
===Laboratory Findings===
An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name].
OR
Laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].
OR
[Test] is usually normal among patients with [disease name].
OR
Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].
OR
There are no diagnostic laboratory findings associated with [disease name].
===Electrocardiogram===
===Electrocardiogram===
There are no ECG findings associated with [disease name].
OR
An ECG may be helpful in the diagnosis of [disease name]. Findings on an ECG suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
===X-ray===
===X-ray===
There are no x-ray findings associated with [disease name].
OR
An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
OR
There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
===Echocardiography or Ultrasound===
===Echocardiography or Ultrasound===
There are no echocardiography/ultrasound  findings associated with [disease name].
OR
Echocardiography/ultrasound  may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
OR
There are no echocardiography/ultrasound  findings associated with [disease name]. However, an echocardiography/ultrasound  may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
===CT scan===
===CT scan===
There are no CT scan findings associated with [disease name].
OR
[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
OR
There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
===MRI===
===MRI===
There are no MRI findings associated with [disease name].
OR
[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
OR
There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
===Other Imaging Findings===
===Other Imaging Findings===
There are no other imaging findings associated with [disease name].
OR
[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
===Other Diagnostic Studies===
===Other Diagnostic Studies===
There are no other diagnostic studies associated with [disease name].
OR
[Diagnostic study] may be helpful in the diagnosis of [disease name]. Findings suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
OR
Other diagnostic studies for [disease name] include [diagnostic study 1], which demonstrates [finding 1], [finding 2], and [finding 3], and [diagnostic study 2], which demonstrates [finding 1], [finding 2], and [finding 3].
==Treatment==
==Treatment==
===Medical Therapy===
===Medical Therapy===
There is no treatment for [disease name]; the mainstay of therapy is supportive care.
OR
Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].
OR
The majority of cases of [disease name] are self-limited and require only supportive care.
OR
[Disease name] is a medical emergency and requires prompt treatment.
OR
The mainstay of treatment for [disease name] is [therapy].
OR
 
The optimal therapy for [malignancy name] depends on the stage at diagnosis.
OR
[Therapy] is recommended among all patients who develop [disease name].
OR
Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
OR
Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
OR
Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
OR
Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
===Surgery===
===Surgery===
Surgical intervention is not recommended for the management of [disease name].
OR
Surgery is not the first-line treatment option for patients with [disease name]. Surgery is usually reserved for patients with either [indication 1], [indication 2], and [indication 3]
OR
The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either [indication 1], [indication 2], and/or [indication 3].
OR
The feasibility of surgery depends on the stage of [malignancy] at diagnosis.
OR
Surgery is the mainstay of treatment for [disease or malignancy].
===Primary Prevention===
===Primary Prevention===
There are no established measures for the primary prevention of [disease name].
OR
There are no available vaccines against [disease name].
OR
Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].
OR
[Vaccine name] vaccine is recommended for [patient population] to prevent [disease name]. Other primary prevention strategies include [strategy 1], [strategy 2], and [strategy 3].
===Secondary Prevention===
===Secondary Prevention===
There are no established measures for the secondary prevention of [disease name].
OR
Effective measures for the secondary prevention of [disease name] include [strategy 1], [strategy 2], and [strategy 3].
==References==
==References==
{{reflist|2}}
{{reflist|2}}

Latest revision as of 17:38, 1 April 2021

WikiDoc Resources for Nasal Septal Hematoma

Articles

Most recent articles on Nasal Septal Hematoma

Most cited articles on Nasal Septal Hematoma

Review articles on Nasal Septal Hematoma

Articles on Nasal Septal Hematoma in N Eng J Med, Lancet, BMJ

Media

Powerpoint slides on Nasal Septal Hematoma

Images of Nasal Septal Hematoma

Photos of Nasal Septal Hematoma

Podcasts & MP3s on Nasal Septal Hematoma

Videos on Nasal Septal Hematoma

Evidence Based Medicine

Cochrane Collaboration on Nasal Septal Hematoma

Bandolier on Nasal Septal Hematoma

TRIP on Nasal Septal Hematoma

Clinical Trials

Ongoing Trials on Nasal Septal Hematoma at Clinical Trials.gov

Trial results on Nasal Septal Hematoma

Clinical Trials on Nasal Septal Hematoma at Google

Guidelines / Policies / Govt

US National Guidelines Clearinghouse on Nasal Septal Hematoma

NICE Guidance on Nasal Septal Hematoma

NHS PRODIGY Guidance

FDA on Nasal Septal Hematoma

CDC on Nasal Septal Hematoma

Books

Books on Nasal Septal Hematoma

News

Nasal Septal Hematoma in the news

Be alerted to news on Nasal Septal Hematoma

News trends on Nasal Septal Hematoma

Commentary

Blogs on Nasal Septal Hematoma

Definitions

Definitions of Nasal Septal Hematoma

Patient Resources / Community

Patient resources on Nasal Septal Hematoma

Discussion groups on Nasal Septal Hematoma

Patient Handouts on Nasal Septal Hematoma

Directions to Hospitals Treating Nasal Septal Hematoma

Risk calculators and risk factors for Nasal Septal Hematoma

Healthcare Provider Resources

Symptoms of Nasal Septal Hematoma

Causes & Risk Factors for Nasal Septal Hematoma

Diagnostic studies for Nasal Septal Hematoma

Treatment of Nasal Septal Hematoma

Continuing Medical Education (CME)

CME Programs on Nasal Septal Hematoma

International

Nasal Septal Hematoma en Espanol

Nasal Septal Hematoma en Francais

Business

Nasal Septal Hematoma in the Marketplace

Patents on Nasal Septal Hematoma

Experimental / Informatics

List of terms related to Nasal Septal Hematoma

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Synonyms and keywords:

Overview

Historical Perspective

Classification

There is no established system for the classification of nasal septal hematoma.

Classification of heamatoma
Type 1
Type 2
Type C Type Ca
Type Cb

Pathophysiology

Anatomy

  • All these blood vessels form an anastomosis known as Kiesselbach plexus which is found in the anterior inferior third of the nasal septum.

Pathogenesis

  • When the nasal cartilage is fractured, blood can dissect and form hematoma, which may be bilateral.
  • The exact pathogenesis of development of hematoma is not fully understood.
  • Though septal cartilage is an avascular structure, it gets nourished from the overlying perichondrium.
  • Any trauma to nasal septum disrupts the blood supply to the perichondrium due to external force that pull the closely adherent mucoperichondrium from the underlying cartilage.
  • Hematoma sets in the vacant space due to the rupture of submucosal vessels.
  • Further expansion of the hematoma exerts pressure induced ischemic changes on the cartilage.
  • If not rapidly evacuated, pressure-induced ischemic changes leads to avascular necrosis of the nasal cartilage ultimately into perforation
  • The accumulated blood and necrotic tissue also form a nidus for infection with bacteria that colonize the nasal mucosa.
  • Once necrosis and/or septal abscess occur, the replacement of necrotic tissue by fibrous tissue, retraction of scar tissue, and loss of support to the lower nose may lead to facial deformity, including saddle nose, displacement of the maxilla, retraction of the anterior nasal septum (columella), widening of the nasal base, and diminished size of the nasal cavity
  • This causes the rupture of submucosal vessels which ultimately causes a collection of blood between the cartilage and the perichondrium.
  • Hematoma thus formed, results in pressure-related ischaemic changes and the subsequent necrosis of the septal cartilage.
  • If the trauma is severe enough, the septal cartilage gets fractured, and blood sweeps to the opposite side resulting in a bilateral septal hematoma.
  • This situation is more hazardous as it doubles the compromise on the nutrient supply of septal cartilage and hastens the process of cartilage necrosis.
  • Hematoma acts as an ideal medium for bacterial proliferation and colonization.

Causes

  • The most common cause of nasal septal hematoma is nasal trauma.
    • Nasal trauma can be secondary to sports injuries, road-side accidents, falls, assault or occupational injuries.
    • Even a minor injury can lead to nasal septal hematoma, especially in children.
  • Nasal septal hematoma without history of injury must look into the suspicion of child abuse.
  • Iatrogenic septal hematoma may arise as a complication of nasal surgeries.
  • Atraumatic septal hematoma is rarely seen in patients with bleeding diathesis or as an adverse effect of antiplatelet/anticoagulant drugs.

Differentiating Nasal Septal Hematoma from other Diseases

Nasal septal hematoma must be differentiated from other diseases with similar presentation


Screening

Epidemiology and Demographics

  • The exact incidence of nasal septal hematoma is unknown as majority of the cases are undiagnosed.
  • However, from the reported cases of nasal injuries incidence of septal hematoma was 0.8% to 1.6%.

Risk Factors

  • The most potent risk factor in the development of nasal septal hematoma is injury to the nose.
  • Risk factors for nose injury include:
    • Contact sports
    • Motor vehicle accident (MVA)
    • Recental nasal surgery
    • Nasal fracture

Screening

The [a'dajfa'g

When to screen

  • WHen the patoient comes with bleeding
  • WHen they invokve in fight

Natural History, Complications, and Prognosis

Natural History

  • If left untreated, the infection can spread to the nearby anatomical structures like paranasal sinuses, orbit or intracranial structures, through the venous draining the mid-face.
  • Avascular necrosis and secondary infection can lead to the collapse of septal cartilage causing various types of nasal deformities.  
  • In children, destruction can cause an altered growth of mid-face and permanent facial deformity.

Complications

Common complications associated with untreated septal hematoma include:

Local
  • Septal abscess
  • Saddle nose
  • Deviated nasal septum
  • Nasal valve collapse
  • Sinusitis
  • Facial cellulitis
  • Nasal vestibulitis
Systemic
  • Sepsis
  • Bacteremia
Orbital
  • Orbital cellulitis
  • Sub-periosteal abscess
  • Orbital abscess
Intracranial Complications
  • Cavernous sinus thrombosis
  • Epidural abscess
  • Meningitis


Prognosis

If hematoma is not evacuated early, it may lead to irreversible damage as soon as 24 hours after injury.

Diagnosis

Diagnostic Study of Choice

Nasal septal hematoma is a clinical diagnosis. The diagnosis of septal hematoma can be established by taking a careful history and performing complete physical examination.

History and Symptoms

The majority of patients with nasal septal hematoma presents within within the first 24 to 72 hours after trauma. The most common symptom are

  • Nasal obstruction ( unilateral or bilateral)
  • Pain
  • Rhinorrhea
  • Fever
  • Nasal deformity /Nasal pain

Physical Examination

Clinical examination of nasal septal hematoma is usually confirmatory. Findings on nasal speculum or otoscope include

  • Blood clots
  • Asymmetry of the septum with bluish or reddish mucosal swelling suggests a hematoma.
  • On direct palpation by inserting the little finger feels soft and fluctuant in contrast to deviated nasal septum which will be firm and concave on the opposite side.
  • Lack of reduction in size on the application of vasoconstrictive agents.
Examination Physical Findings
Inspection Identifies location and extent of nasal injury
  • Epistaxis, edema, and ecchymosis suggest septal injury
Palpation Tenderness over the tip of nose is specific for septal hematoma
Examination of the nasal cavity Findings suggestive of septal hematoma include:
  • Asymmetry of the septum
  • Blue or red discoloration of the nasal septum
  • Nasal mucosal swelling obstructing the nasal passage
  • Lack of reduction in size on the application of vasoconstrictive agents.

Laboratory Findings

Electrocardiogram

X-ray

Echocardiography or Ultrasound

CT scan

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

References


Template:WikiDoc Sources

Retrieved from "https://www.wikidoc.org/index.php?title=Nasal_Septal_Hematoma&oldid=1695933"