A 10-year-old boy presents two days after nasal trauma with a boggy, painful swelling of both sides of the septum and worsening nasal obstruction. What is the correct next step and the main reason for it?

• A Observation, the swelling resolves spontaneously within a week
• B Incision and drainage of the collection, to prevent septal abscess with cartilage destruction and saddle nose deformity ✓
• C Immediate septoplasty, to realign the fractured cartilage
• D Intravenous antibiotics alone, since haematomas always reabsorb with antibiotics

Explanation

Bilateral boggy septal swelling after trauma is a septal hematoma. Because the septal cartilage gets its nutrition from the overlying perichondrium, an undrained hematoma strips the perichondrium and leads to cartilage necrosis, abscess formation, and a saddle nose deformity. Treatment is early incision and drainage followed by nasal packing and antibiotics. Antibiotics alone or observation invite these complications.

Reference: Dhingra, Diseases of Ear, Nose and Throat, 8th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.