Nasal septum hematoma refers to the accumulation of blood beneath the perichondrium or periosteum of the nasal septum, often bilateral. Nasal septum abscess refers to the accumulation of pus in the same region, typically resulting from secondary infection of a hematoma.
Etiology
Nasal Septum Hematoma
This condition forms when blood vessels in the nasal septum are damaged, leading to bleeding beneath the mucoperichondrium or mucoperiosteum without rupture. It is commonly associated with nasal trauma or septal fractures. It may also occur as a complication of nasal septum correction surgery or submucous resection of the nasal septum. Spontaneous nasal septum hematomas unrelated to trauma or surgery are rare.
Nasal Septum Abscess
This condition is most often caused by secondary infection of a nasal septum hematoma. In rare cases, it can result from furuncles in adjacent tissues, acute sinusitis, influenza, scarlet fever, or typhoid fever. Therefore, it may also develop in neonates and young children.
Clinical Manifestations
Nasal Septum Hematoma
Symptoms typically include bilateral nasal obstruction, frontal headache, and a feeling of pressure over the nasal bridge. Systemic symptoms are usually absent. Examination may reveal bilateral, symmetrical, semi-circular swelling of the nasal septum with normal or dark reddish mucosa. The swelling is soft to the touch and unresponsive to vasoconstrictors. Aspiration yields blood.
Nasal Septum Abscess
In addition to bilateral nasal obstruction, frontal headache, and nasal bridge pressure, there are also prominent systemic and local acute inflammatory signs, such as chills, fever, general malaise, and redness, swelling, heat, and pain over the nasal bridge and tip. Examination may reveal symmetrical bulging of the nasal septum with dark reddish mucosa that is soft, fluctuant, and tender to palpation. The swelling is unresponsive to vasoconstrictors, and aspiration yields pus.
Diagnosis
A clear diagnosis can be established based on a history of trauma or nasal septum surgery, combined with symptoms, physical findings, nasal endoscopic examination, unresponsiveness of nasal swelling to vasoconstrictors, and the results of aspiration (blood indicating hematoma and pus indicating abscess).
Treatment
The treatment principle involves local aspiration or incision for drainage, combined with systemic antibiotic therapy.
Nasal Septum Hematoma
For smaller hematomas, medical aspiration can be used to remove the blood. Larger hematomas require an L-shaped incision at the lowest point of the hematoma under local anesthesia to evacuate the accumulated blood or clots. After aspiration or incision and drainage, bilateral nasal cavities are packed with materials such as vaseline gauze, expandable sponges, or gelatin sponges to symmetrically compress the nasal septum. Systemic antibiotics are used to prevent infection.
Nasal Septum Abscess
Once the diagnosis is confirmed, immediate incision and drainage are necessary. Necrotic cartilage should be excised, and drainage tubes should be placed, with daily irrigation of the pus cavity. The nasal cavity is not packed in this scenario, and systemic antibiotics are used to control the infection. If extensive necrosis of the nasal septal cartilage leads to complications such as columella collapse or saddle nose, secondary rhinoplasty may be performed to restore structure.