A 16-year-old presents with nasal septal hematoma following trauma. The septal swelling is bilateral, bluish, and fluctuant. What is the most important complication that must be prevented, and what is the appropriate management?
- A Septal perforation; systemic antibiotics only
- B Saddle nose deformity due to cartilage necrosis; incision and drainage with quilting sutures ✓
- C Cavernous sinus thrombosis; immediate surgical drainage
- D Epistaxis; anterior nasal packing
Correct answer: B. Saddle nose deformity due to cartilage necrosis; incision and drainage with quilting sutures
Explanation
Septal hematoma disrupts the vascular supply of the nasal septal cartilage, leading to avascular necrosis. This results in loss of structural support and saddle nose deformity. The hematoma must be evacuated immediately (incision and drainage) followed by quilting sutures or nasal splints to prevent reaccumulation. Antibiotics are given secondarily. Packing alone is insufficient, and delay in drainage is the primary cause of cosmetic deformity.
Reference: Bailey and Love's Short Practice of Surgery, 28th ed.
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Written and medically reviewed by the StethoPrep medical team.