An injury to the nose can rupture blood vessels in and around the septum where there is both bone and cartilage. As the blood clots to stop the bleeding, it forms a hematoma.
Hematomas in most other areas of the body are usually reabsorbed over time, much as happens to a bruise. Septal hematomas, however, tend not to heal on their own and need to be drained promptly in most cases.
- If left untreated, a septal hematoma can cause serious complications.
- A septal hematoma almost always follows an injury to the nose.
- No specific action can prevent a septal hematoma following a nose injury.
- In most cases, a septal hematoma must be drained.
What is a septal hematoma?
The tissue of the septum can be severely damaged, causing the nose to become painful and deformed.
If this happens, and a hematoma blocks blood flow to the septum, it may lead to tissue necrosis or the death of the septum tissue.
Rarely, and particularly if accompanied by a broken nose, a septal hematoma can cause a severe and potentially life-threatening infection.
A septal hematoma inside both nostrils.
Image credit: BruceBlaus, 2017
People who have been hit in the nose can develop a hematoma hours, days, or sometimes weeks after the injury occurred.
When the hematoma develops soon after the injury, a person might mistakenly view their symptoms as resulting from the injury, not from the hematoma. For this reason, it is vital for a person to seek medical care for any serious nose injury.
Anyone who has fractured their nose can develop a nasal hematoma. It is important that they check for the symptoms of a broken nose, including the following:
- bleeding after a blow to the nose
- swelling around the nose or under the eyes
- bleeding a few hours after the initial injury
- clear drainage from the nose
- changes in the shape or size of the nose
The primary symptom of a septal hematoma is a blockage in the nose.
The blockage can be on just one side or both sides. It may be worse on one side than on the other, depending on the location of the hematoma. There may be a visible, smooth red mass inside the nostril, but the hematoma is not always visible. Following the development of a hematoma, the nose may be soft.
Because a septal hematoma demands prompt treatment, people experiencing difficulty breathing, significant swelling, a feeling of fullness or a blockage in the nose, following an injury, should seek prompt medical care.
When a hematoma becomes infected, it can cause intense pain, fever, swollen lymph nodes, and heat on or near the nose. Tissue death can cause a deformity of the nose.
In newborn babies and very young infants, who must breathe through the nose, a septal hematoma can cause intense pain. Parents should seek immediate medical care following any injury to a child's nose.
If a baby is crying and agitated without a known cause, a septal hematoma is one possibility.
Doctors are not certain why some people develop hematomas following a nose injury while others do not.
One factor may be how a nose injury affects the mucous membranes. When blood vessels break open, but the mucous membranes do not, it allows blood to accumulate inside the mucous membranes, causing a hematoma.
A nasal hematoma may develop if someone has fractured their nose.
Researchers have not identified any specific genetic or lifestyle risk factors for a septal hematoma. The primary risk factor is simply an injury to the nose.
Causes of a heightened nose injury risk include:
- playing contact or fighting sports, such as football or boxing
- being in a car or motorcycle accident
- a recent blow to the nose, such as in a fight or following a fall
- recent surgery to the nose
- a break to the nose
An individual can only aim to reduce the risk of nose injuries by wearing the right protective equipment when playing sports, and protecting the nose from blows, as much as possible.
People who have recently experienced a nose injury should seek prompt treatment. Proper care for a broken nose, especially having the injury set if necessary, can prevent a hematoma.
If a hematoma has already formed or is forming, prompt medical care can drain the injury before it causes lasting harm.
Draining may be a recommended surgical procedure that can be performed under local anesthetic.
Draining is a surgical procedure that, in most cases, can be performed with a local anesthesia that allows a person to remain awake during the drainage.
A doctor will cut into the nose to drain the blood and then may pack it with gauze to reduce bleeding and keep it stable.
In some cases, the surgery might need to be done under general anesthesia, particularly when dealing with babies and very young children.
Babies, who must breathe through their noses, may need additional care, including the placement of a tube to help them breathe while the hematoma heals.
If a septal hematoma is left untreated, the treatment needed later on becomes more complicated.
Infections are common when there is a delay in treatment, and they may require antibiotics, either in pill form or given intravenously or through a tube in a vein.
A doctor may also have to drain swelling, surrounding the infection, or remove damaged or dead tissue.
An untreated septal hematoma may cause the septum of the nose to collapse or to separate, leading to what is called a deviated septum. This can cause difficulty breathing and chronic sinus problems.
Surgery can sometimes correct problems with the septum and may even improve the appearance of the nose. However, it is not always possible to fully restore the nose to its original look.
When large pieces of tissue are deformed or dead, it may be possible to use a graft to replace cartilage or other parts. A graft is when a doctor replaces tissue, usually with tissue from somewhere else on the person's body.
Following drainage of a septal hematoma, a person may experience pain and swelling. Ice packs and pain medications, such as ibuprofen, may help. If the pain is intense or suddenly gets much worse, they should consult their doctor.
A septal hematoma always requires medical treatment and must be drained. With prompt treatment, it is a minor complication of a broken nose. Left untreated, it can permanently change a person's appearance.
Due to the potential severity of the condition, it is always better to seek prompt care for a nose injury, even if a person is uncertain about the extent of the injury they have received.