A 28-year-old sustains a blunt nasal trauma. Two days later, examination reveals a smooth, fluctuant, bilateral septal swelling that obliterates both nasal passages, is non-reducible, and is tender. What is the MOST urgent complication that must be addressed within 1 week?
- A Nasal bone malunion
- B Avascular necrosis of the septal cartilage leading to saddle nose deformity ✓
- C Cavernous sinus thrombosis
- D Development of rhinophyma
Correct answer: B. Avascular necrosis of the septal cartilage leading to saddle nose deformity
Explanation
A bilateral septal swelling following nasal trauma represents a septal hematoma — blood collecting between the perichondrium and septal cartilage (which is avascular and depends on perichondrium for nutrition). If untreated, it leads to avascular necrosis of the cartilage within 3–5 days, followed by fibrous organization causing a 'saddle nose' (saddling deformity). Urgent incision and drainage with through-and-through sutures or quilting, plus nasal packing to prevent re-accumulation, are required. Cavernous sinus thrombosis is a remote complication of septal abscess.
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.