Two days after blunt nasal trauma, a 20-year-old man presents with a soft, fluctuant, boggy swelling involving both sides of his nasal septum. The nose is diffusely blocked and the swelling does not blanch fully. What is the correct immediate management?

• A Immediate closed reduction of the nasal bones
• B Aspiration alone under topical anaesthesia and discharge
• C Intravenous steroids and observation for spontaneous resolution
• D Incision and drainage followed by anterior nasal packing and antibiotics ✓

Explanation

D bilateral septal haematoma strips the perichondrium from both sides of the quadrilateral cartilage, cutting off its blood supply. Untreated, it progresses to septal abscess and then cartilage necrosis, giving a saddle nose deformity, and an abscess can spread by the valveless veins towards the cavernous sinus. Management is early incision and drainage, packing to prevent reaccumulation, and antibiotics. Simple aspiration has a high rate of recurrence, steroids have no role, and reduction of nasal bones addresses a different injury entirely.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.