Technique of Incision and Drainage of Septal Hematoma/Septal Abscess

Overview

A septal hematoma is a collection of blood between the cartilage or bone of the nasal septum and its covering mucoperichondrium or mucoperiosteum.

Septal hematoma or abscess is a serious condition that requires prompt treatment to prevent complications.

Anatomy of the Nasal Septum

The nasal septum consists of:

1. Cartilaginous septum

The anterior part of the septum.
2. Bony septum

The posterior part of the septum.
3. Mucoperichondrium

The layer of tissue covering the cartilaginous septum.
4. Mucoperiosteum

The layer of tissue covering the bony septum.

Location of Hematoma or Abscess

The hematoma or abscess typically occurs between the mucoperichondrium or mucoperiosteum and the underlying cartilage or bone.

Epidemiology

Septal hematoma or abscess can occur in anyone, but it is more common in children and young adults.

Pathophysiology

The hematoma or abscess forms when blood or pus accumulates in the space between the mucoperichondrium or mucoperiosteum and the underlying cartilage or bone.

Aetiological Factors

1. Trauma

Nasal trauma is a common cause of septal hematoma.
2. Infection

Bacterial infection can lead to the formation of a septal abscess.

Symptoms and signs

Symptoms

Nasal obstruction: Difficulty breathing through the nose.
Nasal pain: Pain or discomfort in the nose.
Swelling: Swelling of the nasal septum.

Signs

Nasal septal deviation: The nasal septum may be deviated or displaced.
Purulent discharge: Pus may be visible in the nasal cavity.

Diagnosis

Clinical Examination and Diagnosis

The diagnosis is typically made based on clinical examination and history.

Investigations

Imaging studies: CT or MRI scans may be used to assess the extent of the hematoma or abscess.

Complications

1. Septal perforation

Untreated septal hematoma or abscess can lead to septal perforation.
2. Nasal deformity

Septal hematoma or abscess can cause nasal deformity if not treated promptly.

Management

A nasal septal hematoma treatment or management can be done by the following:

Incision and drainage:

The hematoma or abscess should be drained promptly. This procedure is done through the following steps.

Step-by-Step Technique of Incision

1. Preparation

The patient should be prepared for the procedure.
2. Anesthesia

Local anesthesia may be used to numb the area.
3. Incision

A small incision is made in the mucoperichondrium or mucoperiosteum, parallel to the septum.
4. Drainage

The hematoma or abscess is drained, and the cavity is irrigated with saline solution.
5. Packing

The cavity may be packed with gauze or a nasal splint to prevent re-accumulation of blood or pus.

Post-Incision and Drainage Management

1. Antibiotics

Antibiotics may be prescribed to prevent or treat infection.
2. Nasal saline irrigations

Nasal saline irrigations may be used to keep the nasal cavity clean.
3. Follow-up

The patient should be followed up regularly to monitor for complications.

By following these steps, septal hematoma or abscess can be effectively managed, and complications can be prevented.

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