A 22-year-old man sustained a nasal injury during a boxing match. Examination shows a soft, fluctuant, tender swelling involving both sides of the nasal septum with intact overlying mucosa, causing near-total nasal obstruction. The most appropriate immediate management is:

• A Oral antibiotics alone with review after one week
• B Immediate septoplasty with cartilage grafting
• C Incision and drainage followed by anterior nasal packing ✓
• D Observation, as the collection resorbs spontaneously

Explanation

The findings describe a septal haematoma. Because the septal cartilage has no independent blood supply and depends on the overlying perichondrium, an undrained haematoma separates cartilage from perichondrium, leading to abscess formation and cartilage necrosis. The sequelae are saddle nose deformity and septal perforation. Incision and drainage with packing to appose the flaps is required even if the collection appears sterile, and antibiotics are added to prevent abscess.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.