Nasal Septal Hematoma: Difference between revisions
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==Pathophysiology== | ==Pathophysiology== | ||
* The anterior part of the nasal septum consists of a thin cartilaginous layer with closely adherent mucosa and perichondrium. | *The anterior part of the nasal septum consists of a thin cartilaginous layer with closely adherent mucosa and perichondrium. | ||
* The nasal septum is about 3-4 mm thick and derives its blood supply from the anterior and posterior ethmoid arteries and the sphenopalatine artery. | *The nasal septum is about 3-4 mm thick and derives its blood supply from the anterior and posterior ethmoid arteries and the sphenopalatine artery. | ||
* The area known as Kiesselbach plexus is found in the anterior inferior third of the nasal septum, where all the key blood vessels anastomose. | *The area known as Kiesselbach plexus is found in the anterior inferior third of the nasal septum, where all the key blood vessels anastomose. | ||
* When the nasal cartilage is fractured, blood can dissect and form hematoma, which may be bilateral. | *When the nasal cartilage is fractured, blood can dissect and form hematoma, which may be bilateral. | ||
* The exact mechanism underlying the formation of nasal septal hematoma remains controversial. | *The exact mechanism underlying the formation of nasal septal hematoma remains controversial. | ||
* Septal cartilage is an avascular structure, 2 mm to 4 mm thick, which receives its nutrients supply from the overlying perichondrium. | *Septal cartilage is an avascular structure, 2 mm to 4 mm thick, which receives its nutrients supply from the overlying perichondrium. | ||
* Physicians hypothesize that trauma results in sharp buckling forces that pull the closely adherent mucoperichondrium from the underlying cartilage. | *Physicians hypothesize that trauma results in sharp buckling forces that pull the closely adherent mucoperichondrium from the underlying cartilage. | ||
* This causes the rupture of submucosal vessels which ultimately causes a collection of blood between the cartilage and the perichondrium. | *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. | *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. | *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. | *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. | *Hematoma acts as an ideal medium for bacterial proliferation and colonization. | ||
* If left untreated, it gets infected within 72 hours leading to the formation of a septal abscess. | *If left untreated, it gets infected within 72 hours leading to the formation of a septal abscess. | ||
==Causes== | ==Causes== | ||
| Line 48: | Line 48: | ||
==Diagnosis== | ==Diagnosis== | ||
===Diagnostic Study of Choice=== | ===Diagnostic Study of Choice=== | ||
Nasal septal hematoma is a clinical diagnosis. | |||
===History and Symptoms=== | ===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=== | ===Physical Examination=== | ||
Clinical examination of nasal septal hematoma is usually confirmatory. Findings on nasal speculum or otoscope include | |||
* Blood clots, (should be suctioned) | |||
* Asymmetry of the septum with bluish or reddish mucosal swelling suggests a hematoma. | |||
* A newly formed hematoma is not always ecchymotic and can only be picked up by palpation. | |||
* 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. | |||
* Another important feature of septal hematoma is the lack of reduction in size on the application of decongestant sprays like oxymetazoline 0.05%. | |||
===Laboratory Findings=== | ===Laboratory Findings=== | ||
===Electrocardiogram=== | ===Electrocardiogram=== | ||
Revision as of 15:30, 23 March 2021
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Synonyms and keywords:
Overview
Historical Perspective
Classification
Pathophysiology
- The anterior part of the nasal septum consists of a thin cartilaginous layer with closely adherent mucosa and perichondrium.
- The nasal septum is about 3-4 mm thick and derives its blood supply from the anterior and posterior ethmoid arteries and the sphenopalatine artery.
- The area known as Kiesselbach plexus is found in the anterior inferior third of the nasal septum, where all the key blood vessels anastomose.
- When the nasal cartilage is fractured, blood can dissect and form hematoma, which may be bilateral.
- The exact mechanism underlying the formation of nasal septal hematoma remains controversial.
- Septal cartilage is an avascular structure, 2 mm to 4 mm thick, which receives its nutrients supply from the overlying perichondrium.
- Physicians hypothesize that trauma results in sharp buckling forces that pull the closely adherent mucoperichondrium from the underlying cartilage.
- 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.
- If left untreated, it gets infected within 72 hours leading to the formation of a septal abscess.
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 ((Page name)) from other Diseases
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
Screening
Natural History, Complications, and Prognosis
Diagnosis
Diagnostic Study of Choice
Nasal septal hematoma is a clinical diagnosis.
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, (should be suctioned)
- Asymmetry of the septum with bluish or reddish mucosal swelling suggests a hematoma.
- A newly formed hematoma is not always ecchymotic and can only be picked up by palpation.
- 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.
- Another important feature of septal hematoma is the lack of reduction in size on the application of decongestant sprays like oxymetazoline 0.05%.