What Causes a Septal Hematoma?

How important is early diagnosis with a septal hematoma?

Trauma to the nose can cause blood to collect in the septum, which is the area between the nostrils. This is called a septal hematoma. The trauma results in damage or disruption of the blood vessels which leads to the lining of the septum pulling away from the cartilage and creating a pocket, allowing blood to pool and collect. The surrounding area becomes painful and appears bruised, which is a red flag that a septal hematoma may be present.

In general, septal hematomas are caused by some sort of nasal fracture or injury, the most common form of trauma to the face. A broken nose, surgery, or an injury to the soft tissue are all frequent causes of septal hematoma.

Types of Nasal Trauma

Nasal trauma can result from external and internal causes. When some sort of force is exerted on the nose, that is, obviously, external trauma. Some common examples include:

  • Falling
  • Injuries during sporting activities
  • Vehicle accidents
  • Physical assault or abuse

Internal nasal trauma normally occurs when something enters the nose and causes damage to the cartilage or the blood vessels. Common causes of internal nasal trauma include:

  • Inhaling irritants, like chemicals or fumes from cleaners, pesticides, noxious fumes, etc.
  • Infections from nasal piercings
  • Drug use, specifically, sniffing, snorting or inhaling cocaine or other illegal drugs or legal substances, like glue, used for the same purpose
  • Infections from picking or scratching the inside of the nose
  • Placing a foreign object inside the nose, which is very common with children

Because the nasal septum is normally thin and rigid, septal hematomas are usually fairly easy to diagnose. The area will be soft to the touch and your doctor will look for swelling between the nostrils. Symptoms that you may observe on your own can include:

  • Difficulty in breathing through the nose
  • Congestion not explained by a cold or allergy
  • Bruising
  • The overall shape of the nose may appear to be changed
  • Headaches
  • Feeling nauseous
  • Vomiting
  • Feeling faint or actually fainting

Anytime there is trauma to the nose that causes significant pain, bleeding or swelling, it is important to apply ice or a cold pack to the area and make an appointment with your doctor as soon as possible. If there is evidence of a septal hematoma, it will require immediate treatment to prevent further complications. The septal hematoma will need to be drained. Depending on the size of the swelling, this may be done with a small incision that will allow the blood to drain or a larger-sized area may require a more extensive procedure.

It is a mistake to assume that nasal trauma will simply heal itself. Fever, infection or abscess can all be the beginning of much more serious conditions. Left to continue to develop, a septal hematoma can result in the development of a saddle nose or even in the cartilage between the nostrils dying completely from lack of blood supply. It is important to seek advice and treatment from your healthcare professional sooner rather than later.

If you have questions about saddle nose or any other issue related to complications from septal hematoma, you could not make a better decision than consulting with Dr. Geoffrey Tobias, New York City’s only plastic surgeon exclusively practicing rhinoplasty. His experience, compassion and dedication have combined to have him recognized 12 times as “best in his field” by New York Magazine.  To request a consultation, simply click here.  

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