Nasal Septal Hematoma: Difference between revisions
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==Classification== | ==Classification== | ||
==Pathophysiology== | ==Pathophysiology== | ||
* The anterior part of the nasal septum consists of a thin cartilaginous layer with closely adherent mucosa and perichondrium. | |||
* The nasal septum is about 3-4 mm thick and derives its blood supply from the anterior and posterior ethmoid arteries and the sphenopalatine artery. | |||
* The area known as Kiesselbach plexus is found in the anterior inferior third of the nasal septum, where all the key blood vessels anastomose. | |||
* When the nasal cartilage is fractured, blood can dissect and form hematoma, which may be bilateral. | |||
* The exact mechanism underlying the formation of nasal septal hematoma remains controversial. | |||
* Septal cartilage is an avascular structure, 2 mm to 4 mm thick, which receives its nutrients supply from the overlying perichondrium. | |||
* Physicians hypothesize that trauma results in sharp buckling forces that pull the closely adherent mucoperichondrium from the underlying cartilage. | |||
* This causes the rupture of submucosal vessels which ultimately causes a collection of blood between the cartilage and the perichondrium. | |||
* Hematoma thus formed, results in pressure-related ischaemic changes and the subsequent necrosis of the septal cartilage. | |||
* If the trauma is severe enough, the septal cartilage gets fractured, and blood sweeps to the opposite side resulting in a bilateral septal hematoma. | |||
* This situation is more hazardous as it doubles the compromise on the nutrient supply of septal cartilage and hastens the process of cartilage necrosis. | |||
* Hematoma acts as an ideal medium for bacterial proliferation and colonization. | |||
* If left untreated, it gets infected within 72 hours leading to the formation of a septal abscess. | |||
==Causes== | ==Causes== | ||
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==Epidemiology and Demographics== | ==Epidemiology and Demographics== | ||
* The exact incidence of nasal septal hematoma is unknown as majority of the cases are undiagnosed. | *The exact incidence of nasal septal hematoma is unknown as majority of the cases are undiagnosed. | ||
* However, from the reported cases of nasal injuries incidence of septal hematoma was 0.8% to 1.6%. | *However, from the reported cases of nasal injuries incidence of septal hematoma was 0.8% to 1.6%. | ||
==Risk Factors== | ==Risk Factors== | ||
Revision as of 15:22, 23 March 2021
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Synonyms and keywords:
Overview
Historical Perspective
Classification
Pathophysiology
- The anterior part of the nasal septum consists of a thin cartilaginous layer with closely adherent mucosa and perichondrium.
- The nasal septum is about 3-4 mm thick and derives its blood supply from the anterior and posterior ethmoid arteries and the sphenopalatine artery.
- The area known as Kiesselbach plexus is found in the anterior inferior third of the nasal septum, where all the key blood vessels anastomose.
- When the nasal cartilage is fractured, blood can dissect and form hematoma, which may be bilateral.
- The exact mechanism underlying the formation of nasal septal hematoma remains controversial.
- Septal cartilage is an avascular structure, 2 mm to 4 mm thick, which receives its nutrients supply from the overlying perichondrium.
- Physicians hypothesize that trauma results in sharp buckling forces that pull the closely adherent mucoperichondrium from the underlying cartilage.
- This causes the rupture of submucosal vessels which ultimately causes a collection of blood between the cartilage and the perichondrium.
- Hematoma thus formed, results in pressure-related ischaemic changes and the subsequent necrosis of the septal cartilage.
- If the trauma is severe enough, the septal cartilage gets fractured, and blood sweeps to the opposite side resulting in a bilateral septal hematoma.
- This situation is more hazardous as it doubles the compromise on the nutrient supply of septal cartilage and hastens the process of cartilage necrosis.
- Hematoma acts as an ideal medium for bacterial proliferation and colonization.
- If left untreated, it gets infected within 72 hours leading to the formation of a septal abscess.
Causes
- The most common cause of nasal septal hematoma is nasal trauma.
- Nasal trauma can be secondary to sports injuries, road-side accidents, falls, assault or occupational injuries.
- Even a minor injury can lead to nasal septal hematoma, especially in children.
- Nasal septal hematoma without history of injury must look into the suspicion of child abuse.
- Iatrogenic septal hematoma may arise as a complication of nasal surgeries.
- Atraumatic septal hematoma is rarely seen in patients with bleeding diathesis or as an adverse effect of antiplatelet/anticoagulant drugs.
Differentiating ((Page name)) from other Diseases
Epidemiology and Demographics
- The exact incidence of nasal septal hematoma is unknown as majority of the cases are undiagnosed.
- However, from the reported cases of nasal injuries incidence of septal hematoma was 0.8% to 1.6%.