A 22-year-old man has been struck on the bridge of the nose during an altercation outside a nightclub last night. He had a brief episode of epistaxis at the time, which stopped after pressure was applied to the nose. He is complaining of a painful, deformed nose and he is finding it difficult to breathe through his nose. On examining his nose, you see the following:

1. What is the most likely diagnosis?
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This patient has a septal haematoma. Blood has collected in the cavity between the cartilage and the supporting perichondrium. This is typically caused by a shearing force stripping the perichondrium away from the underlying cartilage.

 

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2. How should this patient be managed?

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Management is as follows:

  • Infiltration with local anaesthetic, e.g. 1% lidocaine
  • Drainage / needle aspiration of the haematoma
  • Application of firm nasal packing to prevent re-accumulation
  • Broad spectrum antibiotics
3. What potential complications can occur?
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Potential complications include the following

  • Septal abscess formation
  • Cartilage necrosis
  • Collapse of nasal bridge (‘saddle nose’)
4. How should this patient be followed up?
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He should be followed up in the ENT clinic in one week for assessment of nasal fracture and the septal haematoma.

 

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