General Medical Information

Septal Hematoma

Richard L. Mabry

Frequently the result of traumatic injury to the nose, septal hematoma often manifests as bilateral obstruction. This condition necessitates immediate treatment. Avascular septal cartilage begins to degenerate when the septal perichondrium, its nutrient supply, is nonadherent. Septal degeneration can cause partial or total loss of support of the dorsum of the nose. The result is a characteristic saddle-nose deformity. Epistaxis after traumatic injury usually precludes development of septal hematoma, because blood from epistaxis has a direct exit from the perichondrial space. Management of septal hematoma involves unilateral or bilateral anterior vertical (Killian) incisions through the perichondrium, depending on whether the hematoma is unilateral or bilateral. The Killian incision is made 1 cm parallel to the caudal septal margin. Bilateral incisions should be stepped (staggered posterior and anterior) to prevent through-and-through septal weakness or perforation. After blood within the hematoma is evacuated and bleeding in the region is halted, the nose is packed bilaterally to ensure plication of the perichondrium with the septal cartilage. Broad-spectrum antibiotics are administered for prophylaxis against infection and the development of a septal abscess.