A 30-year-old male presents 12 hours after nasal trauma with a smooth, fluctuant, non-tender swelling obliterating the columellar definition bilaterally. The swelling does not transilluminate. What is the immediate priority in management and why?

• A Incision and drainage of septal hematoma; to prevent avascular necrosis of cartilage and saddle nose deformity ✓
• B CT scan of facial bones; to rule out septal fracture before intervention
• C Closed reduction of the nasal fracture; to restore nasal airway
• D Intranasal steroid spray; to reduce mucosal edema before definitive management

Explanation

The description is of a septal hematoma — blood collection between the perichondrium and the septal cartilage, which relies entirely on the perichondrium for nutrition (as cartilage is avascular). If not drained urgently, pressure-induced avascular necrosis of the cartilage leads to resorption and a saddle nose deformity within 3–5 days. Additionally, it can become infected and form a septal abscess. Treatment is immediate incision and drainage, followed by nasal packing or quilting sutures to prevent reaccumulation. CT scan is not required for this diagnosis, which is clinical.

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.