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?
Show Answer

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.


Image sourced from Wikidot
CC BY-SA 3.0

2. How should this patient be managed?

Show Answer

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?
Show Answer

Potential complications include the following

  • Septal abscess formation
  • Cartilage necrosis
  • Collapse of nasal bridge (‘saddle nose’)
4. How should this patient be followed up?
Show Answer

He should be followed up in the ENT clinic in one week for assessment of nasal fracture and the septal haematoma.


Header image used on licence from Shutterstock