Airway and ENT emergencies
Septal haematoma
Overview and approach
A septal haematoma is blood trapped beneath septal perichondrium after trauma, threatening cartilage viability.
- Blood separates the perichondrium from septal cartilage, cutting off its blood supply; untreated collections can cause cartilage necrosis, septal perforation and saddle nose (1)(2)(3).
Assessment and clinical features
Inspect both sides of the septum for boggy swelling and obstruction, especially after nasal injury.
- Bilateral nasal obstruction after trauma, a red or purple, soft, bulging midline swelling that does not shrink with decongestant; may be painful (1)(3). Children can present after minor trauma.
Differentials and investigations
Clinical examination is key; do not let reassuring plain imaging replace inspection.
- Differentials: deviated septum, turbinate swelling, simple mucosal oedema, septal abscess (fever, pain, tenderness).
- Palpate with a probe or cotton bud if in doubt. Imaging is not needed to diagnose; look for associated nasal or facial fractures if clinically indicated.
Management and follow-up
Urgent same-day ENT assessment for drainage and prevention/treatment of infection.
- Urgent drainage, ideally within hours: aspirate small collections, incise and drain larger ones, then pack, quilt or drain to prevent reaccumulation; prophylactic antibiotics. If abscess: drain, culture pus and give broad-spectrum antibiotics (1)(2)(3).
- Review for reaccumulation and nasal shape.
Red flags and clinical pearls
Delay may cause septal abscess and saddle-nose deformity.
- Septal abscess can spread intracranially (cavernous sinus thrombosis, meningitis): fever, severe pain and swelling need urgent admission.
- Any nasal trauma with obstruction = look inside the nose.
Last updated from Sen’s notes on 9 October 2026.