A patient sustains a nasal injury and presents with a smooth, tense, non-tender, fluctuant swelling entirely within the nasal septum that developed over 48 hours. The immediate management is:

• A Intranasal packing for 48 hours
• B Oral antibiotics and review in 1 week
• C Septoplasty under general anaesthesia
• D Incision and drainage with through-and-through sutures and nasal packing to prevent reaccumulation ✓

Explanation

A septal haematoma (smooth tense bilateral septal swelling, loss of normal septal architecture) requires urgent incision and drainage through a hemitransfixion or stab incision, evacuation of clot, and bilateral nasal packing (or quilting sutures) to prevent reaccumulation and subsequent abscess formation or avascular necrosis of the cartilage (leading to saddle nose deformity). Antibiotics are adjunctive. Intranasal packing alone does not drain the haematoma. Septoplasty is not the acute intervention.

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.