Septal haematoma is caused by bleeding under the perichondrium lining the septal cartilage, typically due to nasal trauma. It is therefore important to inspect the nasal septum after any nasal trauma. Anterior rhinoscopy will show a bilateral cherry-red swelling arising from the nasal septum. Refer all patients suspected of having a septal haematoma to ENT for emergency incision and drainage.
As the septal cartilage receives blood supply from the overlying mucosa, the haematoma can disrupt blood flow. Damage to the septal cartilage can occur within 24 hours and if untreated, this can lead to irreversible septal perforation and necrosis, eventually resulting in saddle-nose deformity. Emergency incision & drainage prevents both life-threatening infective complications and severe cosmetic nasal deformity.