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Nasal septal hematoma

A nasal septal hematoma is a collection of blood within the septum of the nose. The septum is the part of the nose between the nostrils. An injury disrupts the blood vessels so that fluid and blood may collect under the lining.

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Causes

A septal hematoma can be caused by:

• A broken nose
• Injury to the soft tissue of the area
• Surgery
• Taking blood-thinning medicines

The problem is more common in children because their septums are thicker and have a more flexible lining.

Symptoms

Symptoms may include:

• Blockage in breathing
• Nasal congestion
• Painful swelling of the nasal septum
• Change in the shape of the nose
• Fever

Exams and Tests

Your health care provider will look into your nose to see if there is swelling of the tissue between the nostrils. The provider will touch the area with an applicator or a cotton swab. If there is a hematoma, the area will be soft and able to be pressed down. The nasal septum is normally thin and rigid.

Treatment

Your provider will make a small cut to drain the blood. Gauze or cotton will be placed inside the nose after the blood is removed.

Outlook (Prognosis)

You should heal fully if the injury is treated quickly.

Possible Complications

If you have had the hematoma for a long time, it may become infected and will be painful. You may develop a septal abscess and fever.

An untreated septal hematoma may lead to a hole in the area separating the nostrils, called a septal perforation. This can cause nasal congestion. Or, the area may collapse, leading to a deformity of the outer nose called a saddle nose deformity.

When to Contact a Medical Professional

Contact your provider for any nasal injury resulting in nasal congestion or pain. You may be referred to an ear, nose, and throat (ENT) specialist.

Prevention

Recognizing and treating the problem early can prevent complications and allow the septum to heal.

References

Bohm LA, Roby B. Pediatric facial fractures. In: Flint PW, Francis HW , Haughey BH, et al, eds. Cummings Otolaryngology: Head and Neck Surgery. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 191.

Chegar BE, Tatum SA. Nasal fractures. In: Flint PW, Francis HW, Haughey BH, et al, eds. Cummings Otolaryngology: Head and Neck Surgery. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 30.

Haddad J, Dodhia SN. Acquired disorders of the nose. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 405.

Kridel RWH, Sturm A. The nasal septum. In: Flint PW, Francis HW, Haughey BH, et al, eds. Cummings Otolaryngology: Head and Neck Surgery. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 29.

Review Date: 9/10/2023  

Reviewed By: Josef Shargorodsky, MD, MPH, Johns Hopkins University School of Medicine, Baltimore, MD. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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