Typically soft and fluctuant when compressed, a septal hematoma is a collection of blood between the nasal mucosa and the cartilaginous septum. It may occur unilaterally or, more commonly, bilaterally following nasal trauma with or without associated nasal fracture. This urgent condition warrants immediate referral to an otolaryngologist.
Management of septal hematoma includes local anesthesia with needle aspiration or incision and drainage. Several days of nasal packing prevents reaccumulation of blood. Ideally, treatment occurs within a few hours of injury.1 If the hematoma is not cleared, the septal cartilage may become necrotic and result in a saddle nose deformity or septal perforation. Accumulated blood may become infected, and antibiotics should follow drainage if abscess is noted.