A patient with nasal fracture presents 36 hours after injury with a bluish, fluctuant, tender swelling occupying the full width of the nasal septum blocking both nostrils. The most urgent treatment is:

• A Broad-spectrum antibiotics for 7 days and reassessment
• B Immediate incision and drainage with packing to prevent recurrence ✓
• C Aspiration of blood with 21G needle followed by reassessment
• D Reduction of nasal fracture under general anaesthesia first

Explanation

The described lesion is a septal haematoma — blood between the septal cartilage and its perichondrium. It requires urgent surgical incision and drainage (through-and-through L-shaped incisions) and quilting sutures or bilateral through-and-through drain placement to prevent reaccumulation. If untreated, ischemic necrosis of the cartilage leads to saddle-nose deformity, and secondary infection causes septal abscess and intracranial spread. Simple aspiration has a high recurrence rate.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.