Nasal septal hematoma is an accumulation of blood under the cartilage or periosteum on one or both sides of the nasal septum. Infection of the accumulated blood becomes nasal septal abscess. Nasal septal hematoma refers to the accumulation of blood under the cartilage or periosteum of the nasal septum, which is mostly bilateral. It is often formed after trauma to the nose, fracture of the septum, rupture of blood vessels and unbroken bleeding of the mucosa; it can also be complicated after submucosal resection of the nasal septum. Nasal septal hematoma refers to the accumulation of blood under the cartilage or periosteum of the nasal septum and is mostly bilateral. Clinical manifestations 1. Nasal congestion on both sides, headache, and pressure at the bridge of the nose. 2. There are rounded elevations on both sides of the septum, the mucosa is dark red or normal in color, the surface is smooth and soft to touch, and blood can be drawn by puncture. Symptoms and signs There is bilateral nasal congestion, frontal headache and a feeling of pressure at the bridge of the nose, and the examination shows a symmetrical semicircular bulge on both sides of the nasal septum, with a dark red or normal mucous membrane color and soft to the touch. Causes of the disease Local vascular injury and bleeding caused by nasal trauma or nasal septum fracture, but the mucosa is not ruptured and formed. Submucosal resection of the nasal septum and correction of the nasal septum can also complicate the disease. Spontaneous hematoma caused by non-trauma or surgery is rare. Pathophysiology It is formed by local vascular injury and bleeding due to nasal trauma or nasal septal fracture, but the mucosa is not ruptured. Submucosal resection of the nasal septum and correction of the nasal septum can also complicate the disease. Spontaneous hematomas not caused by trauma or surgery are rare. Diagnostic tests Intranasal examination as well as nasal septal augmentation not responding to vasoconstrictors and puncture findings (hematoma if blood is drawn, abscess if pus is drawn) Diagnosis based on 1. History of nasal trauma and septal surgery. 2. There is nasal bone fracture or septal dislocation change on X-ray taking nasal bone phase or sinus phase. 3. The above symptoms and signs are present. Treatment plan Early treatment is desirable. In smaller cases, blood is extracted by puncture. In larger cases, an L-shaped incision should be made at the lowest part of the hematoma under surface anesthesia to remove the stagnant blood or clot; if it occurs after septal surgery, the original incision should be reopened for debridement. After draining the blood or clot, the bilateral nasal cavity should be tightly filled with sterile petroleum jelly gauze and systemic antibiotics should be applied to prevent infection. Treatment principles 1. Small hematomas should be punctured early to extract the accumulated blood. 2. For large hematoma, an “L” shaped incision should be made under local anesthesia to remove the accumulated blood and blood clots from the lowest part of the hematoma. 3.For hematoma complicated by septal surgery, enter through the original incision to remove the clot and accumulated blood, and then use Vaseline gauze to fill the nasal cavity bilaterally (removed after 24 hours). 4.Appropriate application of hemostatic agents. 5. Systemic application of antibiotics to prevent infection. Health care tips: 1.No special prevention methods, must pay attention to trauma. 2.Take out the stuffing 24-48 hours after surgery. 3.Sneezing is forbidden. If you cannot control it, gently pinch your nose tightly and then open your mouth to sneeze. Expert tips: nasal septal hematoma should be promptly extracted or removed from the accumulated blood and actively prevent infection to prevent abscess formation and subsequent saddle nose deformity. In cases caused by trauma, attention should be paid to the combination of jaw and cranial trauma.