What Is A Septal Hematoma? How Is It Treated?

A septal hematoma is a serious condition caused by blood accumulating in the septum after nasal trauma. If left untreated, the nutrition of the cartilage tissue is impaired and permanent deformities may develop. Early diagnosis and surgical drainage are critically important.

Symptoms of a septal hematoma include nasal congestion, pain, swelling, and tenderness. When these findings are observed after trauma, an ear, nose, and throat specialist should be consulted without delay.

Treatment generally involves making a small incision under local anesthesia to drain the accumulated blood. Afterwards, antibiotic treatment is administered to prevent the risk of infection, and intranasal packing may be placed.

A septal hematoma that is not treated promptly may cause cartilage destruction and permanent deformity of the nose. Therefore, emergency surgical treatment plays a critical role in preventing aesthetic and functional losses.

Causes	– Nasal trauma (impact, fracture) – Rhinoplasty or septoplasty surgeries – Bleeding disorders (hemophilia, use of anticoagulant medications) – Severe nasal infections – Irritation of the nasal mucosa due to sinusitis or allergic rhinitis
Symptoms	– Nasal congestion (usually unilateral) – A feeling of fullness in the nose – Pain and tenderness – Changes in the shape of the nose (collapse in advanced cases) – Bloody nasal discharge – Headache and a feeling of pressure in the nasal area
Diagnostic Methods	– Physical examination (detection of swelling through intranasal examination) – Endoscopic examination
Treatment Methods	– Hematoma Drainage: The hematoma is generally drained through a small incision. – Antibiotic Treatment: Antibiotics are prescribed against the risk of infection. – Nasal Packing: Packing may be placed inside the nose to prevent recurrent bleeding. – Surgical Intervention: Surgical drainage and septal repair may be required for large or complicated hematomas.
What Happens If It Is Not Treated?	– Cartilage Destruction (Septal Necrosis): The septum may be damaged because blood circulation is impaired. – Nasal Collapse (Saddle Nose): The nasal bridge may collapse due to cartilage damage. – Chronic Nasal Congestion and Infection: It may cause breathing problems and frequent sinus infections.
Prevention Methods	– Avoiding nasal trauma – Monitoring intranasal swelling and bleeding after surgery

İçindekiler

What Is a Septal Hematoma?

A septal hematoma is a condition requiring emergency intervention that occurs when blood accumulates between the nasal septum, the cartilage and bony structure dividing the nasal cavity into two, and the mucosa covering it. It generally develops after nasal trauma. If left untreated, it may cause infection, cartilage destruction, and nasal deformities. Symptoms include nasal congestion, swelling, and pain in the nose. Treatment is performed with surgical drainage and antibiotics.

What Are the Symptoms of a Septal Hematoma?

A septal hematoma is a health condition characterized by blood accumulation resulting from injury to the septum inside the nose. This condition causes nasal congestion that makes breathing difficult. In addition, painful swelling develops in the nasal septum, creating significant discomfort for patients. The hematoma may cause changes in the shape of the nose, which are generally observed as a noticeable deformity or asymmetry. The following symptoms are also frequently encountered:

Nasal congestion

Painful swelling
Changes in the shape of the nose
Nasal discharge: Bloody or purplish discharge
Fever: Occurs if the hematoma becomes infected
Pressure and discomfort: An uncomfortable sensation of pressure felt inside the nose

Why Does a Septal Hematoma Occur?

A septal hematoma occurs when blood accumulates in the nasal septum. This accumulation generally results from injury to the blood vessels in the nasal septum. Nasal trauma is the most common condition that can cause a septal hematoma. Various situations such as physical impacts, fights, or traffic accidents may lead to such injuries. Nasal surgeries may also cause this complication. In children, inserting a foreign object into the nose is among the main factors that may cause a septal hematoma. Falling face down and collisions may also contribute to the development of a septal hematoma, especially in children.

Factors that may cause a septal hematoma include:

Nasal trauma is the most common cause.
Surgical procedures may cause it, especially after septoplasty and rhinoplasty.
Insertion of a foreign object is a condition most commonly encountered in children.
Falls and accidents generally cause septal hematomas in children.

How Is a Septal Hematoma Diagnosed?

The patient’s medical history is reviewed, and information is gathered about recent nasal trauma. During the physical examination, the nasal septum is observed in detail with the assistance of a speculum. This examination is critically important for understanding the condition of the septum.

Physical Examination:

The specialist examines the nasal passages using a nasal speculum.
The septum is carefully palpated with the assistance of an applicator.
The presence of a hematoma is evaluated by checking whether the septal tissue is soft and fluctuant.

Imaging Techniques:

Nasal endoscopy is used to examine the septum in greater detail.
When necessary, CT scans or MRI may be preferred to evaluate the size and severity of the hematoma.

What Are the Treatment Methods for a Septal Hematoma?

First, the treatment process begins with an evaluation of the patient’s condition. A detailed examination of the nasal cavity is essential. During this examination, the aim is to identify any abnormality within the septum with the assistance of a nasal speculum or endoscope. If a hematoma is detected, immediate intervention is required. The drainage procedure is performed to remove the accumulated blood, and the patient is made comfortable with local anesthesia during this process. After the procedure, nasal packing is placed to prevent blood from accumulating again.

Care After Drainage:
Nasal Packing: Used to prevent blood accumulation.
Quilting Sutures: Prevent blood from accumulating again.
Silicone Splints: Preferred to preserve the structure and ensure proper healing.

The use of antibiotics is important for reducing the risk of infection. Regular follow-ups are performed throughout the patient’s recovery process. During these follow-ups, the patient is checked for any signs of infection or complications. Medications such as NSAIDs or acetaminophen may be recommended for the management of pain and swelling. Applying ice may also be beneficial for reducing swelling and pain.

What Are the Risk Factors for Septal Hematoma Formation?

There are various risk factors that may trigger the formation of a septal hematoma. First of all, nasal trauma is the most common cause of this condition. Impacts sustained during sporting activities or physical contact may damage the septum. In addition, inserting a foreign object into the nose or picking the nose with excessive force may damage the septal mucosa and cause a hematoma. The following items list the main risk factors involved in the development of a septal hematoma:

Nasal Trauma:

Contact sports such as boxing and wrestling
Physical fights or traffic accidents

Nose Picking or Insertion of a Foreign Object

Surgical Procedures:

Nasal surgeries, especially procedures such as rhinoplasty

Use of Blood-Thinning Medications:

Anticoagulant medications increase the risk by increasing bleeding

Age and Anatomical Factors:

Children are more susceptible because of their anatomical structures

How Is a Septal Hematoma Treated?

Septal hematoma surgery is the procedure of draining the blood accumulated in the septum. This surgical procedure is performed to prevent complications and restore normal breathing. The surgical process begins with an initial evaluation, during which the patient’s general health condition is checked and preparations are made for surgery. After anesthesia is administered under good lighting, the patient is placed in a comfortable sitting position.

Initial Evaluation and Preparation:

The patient’s condition is evaluated.
Anesthesia is administered.

During the visualization stage, the affected area is carefully examined. The location of the septal hematoma is identified with a nasal speculum. An appropriate blade is then used to make a careful incision over the hematoma. This incision allows the blood accumulated inside the hematoma to be drained.

Visualization and Incision:

The hematoma area is exposed with a speculum.
The appropriate site for the incision is identified, and the procedure is performed.

During the drainage procedure, the accumulated blood and clots are carefully aspirated. This step is critically important for reducing the risk of infection and accelerating the healing process. Continuous drainage is provided by leaving the incision site open and using packing if necessary.

Drainage:

Draining the blood through aspiration.
Packing is placed if necessary.

What Are the Complications After Septal Hematoma Surgery?

Patients may experience various health problems after septal hematoma surgery. These complications are generally serious conditions requiring careful attention and early intervention. First of all, infection may damage the septal cartilage and lead to aesthetic and functional problems. This condition especially manifests as a “saddle nose” deformity. In addition, bleeding may occur during the early period, and recurrent bleeding may lead to the formation of a new hematoma.

Infection: May result in a septal abscess and severe mucosal damage.
Bleeding: It is frequently seen during the early period and may require additional surgical intervention.
Septal Perforation: A hole may develop in the septum as a result of damage to the mucoperichondrial flaps.
Cerebrospinal Fluid Leakage: Incorrect interventions during surgery may create serious health risks.
Septal Deviation: Adhesions that develop after surgery may cause nasal congestion.
Meningitis: The spread of infection through the veins may cause serious brain infections.
Chronic Pain: Long-lasting pain may occur in the surgical area.
Atrophic Rhinitis: Develops as a result of thinning and dryness of the nasal mucosa.
Columellar Retraction: Occurs when the tissue separating the nostrils retracts as a result of excessive cartilage removal.
Saddle Nose Deformity: Collapse of the nasal bridge occurs due to loss of septal support.

How Does the Recovery Process Proceed After Septal Hematoma Surgery?

The recovery process after septal hematoma surgery consists of several stages that must be carefully managed to restore the patient’s health. First, during the first 24 hours after surgery, the patient is advised to rest and keep the head elevated. This position minimizes swelling and bleeding. It is also important for the patient to consume sufficient fluids and continue their diet.

Points to consider during the first 24 hours:

Resting and keeping the head elevated
Consuming sufficient fluids
Continuing the diet
Not blowing the nose
Moisturizing the nose with saline solution
Using paracetamol

During the first week, the patient should avoid strenuous activities. Procedures such as dressing changes should be performed in accordance with the doctor’s examinations and recommendations. In addition, the patient should be continuously monitored for any signs of complications. Light exercise may be started during this stage of the recovery process.

Things to do during the first week:

Attending follow-up appointments
Avoiding heavy lifting and bending over
Beginning light activities

Between two and six weeks, activities may be gradually increased. However, it is important to avoid contact sports and heavy lifting. During this period, attention should be paid to signs of infection.

Points to follow during the period from two to six weeks:

Increasing the activity level in a controlled manner
Remaining alert to signs of infection
Continuing nasal hygiene

Complete healing of the cartilage and nasal tissues is expected over a period lasting up to one year. During this process, improvements in the patient’s breathing and swelling may vary. The patient can generally return to completely normal activities after 12 weeks.

Is There a Possibility of Recurrence After Septal Hematoma Surgery?

Recurrence after septal hematoma surgery is an important concern for patients. Surgical techniques and patient characteristics are among the main factors affecting the likelihood of recurrence. In particular, the selection of drainage methods plays a critical role in reducing this risk. Recurrence rates generally range between five percent and thirty-three percent and vary according to the surgical method used. Certain risk factors may increase the likelihood of recurrence:

Elderly patients
Use of anticoagulant medications
Presence of a bilateral hematoma

In addition, the risk of recurrence is higher in patients with chronic health conditions. Conditions such as hypertension or diabetes may predispose the hematoma to recur. The structural characteristics of the hematoma may also determine the frequency of recurrence. Hematomas with a complex structure containing internal septations and membranes tend to recur more frequently than those with a more homogeneous structure.

Frequently Asked Questions

Which symptoms may indicate a septal hematoma after nasal trauma?

A septal hematoma develops as a result of blood accumulating in the nasal septum. Nasal congestion, pain, tenderness, difficulty breathing, and an increasing feeling of fullness after trauma are among the most common symptoms.

Why is a septal hematoma considered an ear, nose, and throat problem requiring emergency treatment?

An untreated septal hematoma may impair the blood supply to the nasal cartilage. Since this condition may lead to tissue loss, infection, and permanent nasal deformities, early intervention is extremely important.

How can the difference between a septal hematoma and simple nasal swelling be understood?

Simple swelling generally involves superficial edema, whereas a septal hematoma creates a soft and swollen area inside the nose. Specialist evaluation may be required in the presence of persistent congestion and pain after trauma.

Why should a septal hematoma be evaluated more carefully in children?

Since the nasal cartilage in children is still developing, delayed treatment of a septal hematoma may cause growth problems. Therefore, children with nasal congestion after trauma should be evaluated promptly.

What role does an ear, nose, and throat examination play in diagnosing a septal hematoma?

The diagnosis is generally made through a physical examination. Careful examination of the inside of the nose allows the location, size, and possible complications of the hematoma to be evaluated. Additional imaging methods may be used when necessary.

How is a septal hematoma treated, and is surgical intervention required?

Treatment generally aims to drain the accumulated blood and reduce the risk of infection. In many cases, hematoma drainage is performed through a minor surgical procedure, and the recovery process is monitored.

Which complications may develop if a septal hematoma is not treated?

Serious complications such as cartilage necrosis, septal perforation, nasal deformity, and infection may develop. Structural changes, especially those resulting in collapse of the nasal bridge, may be permanent.

How can the risk of developing a nasal deformity after a septal hematoma be reduced?

Early diagnosis and timely drainage help preserve the nasal cartilage. Regular examinations and following the doctor’s recommendations may significantly reduce the risk of developing a permanent deformity.

How long does the recovery process take after septal hematoma treatment?

The recovery period may vary depending on the size of the hematoma and the treatment applied. While symptoms decrease within a short time in most patients, follow-up examinations may be required to evaluate complete recovery.

What should be done when a septal hematoma is suspected after nasal trauma?

If nasal congestion, pain, or swelling persists after trauma, an ear, nose, and throat specialist should be consulted without delay. Early evaluation allows possible complications to be prevented and appropriate treatment to be planned.

Prof. Dr. Murat Songu

Prof. Dr. Murat Songu – Burun Estetiği (Rinoplasti) Uzmanı

Prof. Dr. Murat Songu, 1976 yılında İzmir’de doğmuş, tıp eğitimini Ege Üniversitesi Tıp Fakültesi’nde tamamladıktan sonra Celal Bayar Üniversitesi Kulak Burun Boğaz Anabilim Dalı’nda uzmanlık eğitimini tamamlamıştır. 2005–2006 yıllarında Fransa’nın Bordeaux kentinde Prof. Vincent Darrouzet ve Dr. Guy Lacher gibi rinoloji alanının önde gelen cerrahlarıyla çalışarak rinoplasti, fonksiyonel burun cerrahisi ve kafa tabanı cerrahisi üzerine ileri eğitim almıştır.

Burun estetiğinde doğal görünüm, nefes fonksiyonunun korunması ve yüz estetiği dengesini ön planda tutan Prof. Dr. Songu, açık teknik rinoplasti, piezo (ultrasonik) rinoplasti, revizyon rinoplasti, burun ucu estetiği ve fonksiyonel septorinoplasti operasyonlarında ulusal ve uluslararası düzeyde tanınan bir cerrahtır. Yurt içi ve yurt dışında çok sayıda rinoplasti kongresinde eğitici ve konuşmacı olarak yer almış; yüz estetiği ve burun cerrahisinde modern tekniklerin yaygınlaşmasına öncülük etmiştir.

100’den fazla bilimsel yayını, kitap bölümü yazarlıkları ve 1700’ü aşkın uluslararası atfıyla rinoplasti alanında Türkiye’nin en saygın akademisyenlerinden biri olan Prof. Dr. Murat Songu, doğal, yüzle uyumlu ve fonksiyonel sonuçlar hedefleyen cerrahi yaklaşımıyla hem bilimsel hem estetik başarıları bir araya getirmektedir.