Trauma to the nasal septum may result in the development of a hematoma. The mucoperichondrium provides the vascular supply to the septal cartilage. Bleeding may lift the mucoperichondrium from the cartilage creating a hematoma. Since the hematoma lifts the mucoperichondrium, the cartilage is deprived from blood supply. If left untreated it may result in cartilage necrosis with subsequent nasal dorsum depression (“saddle nose” deformity), or septal perforation.
Treatment of septal hematoma is performed via small incisions through the mucoperichondrium to evacuate the blood. After the drainage the nose is packed or quilting stitches are put in. Silicone stents can also be used to prevent re-accumulation of the hematoma.
The quilting stitch is a running absorbable suture that goes back and forth across the septum to assure that the mucoperichondrium is pressed against the cartilage, thereby preventing re-accumulation of blood.
Nasal packing is optional.
Alternative method: aspiration
The hematoma may be aspirated in the office using a needle and a syringe. If adequate drainage is accomplished, the nose is packed for a few days and rechecked at the time of package removal.
Note: The hematoma may re-accumulate in which case aspiration drainage can be repeated or a more formal drainage procedure with quilting stitches may be performed.