Best of five
- A. Review in fracture clinic in ten days
- B. Order plain nasal radiographs
- C. Same-day drainage of a septal haematoma with appropriate ENT care
- D. Use topical decongestants only
- E. Start oral antibiotics without drainage
FRCS (ORL-HNS) · SECTION 1 SBA
Nasal septal haematoma
Two days after a football injury, a teenager has bilateral nasal obstruction and a fluctuant boggy septal swelling. The nasal bridge is only minimally displaced. What is the best management?
C. Same-day drainage of a septal haematoma with appropriate ENT care
A septal collection compromises cartilage blood supply and can cause necrosis, abscess, perforation and saddle deformity. The cosmetic fracture assessment must not delay drainage.
Why every option is right or wrong
A. Review in fracture clinic in ten days: That timing is appropriate for some fractures but unsafe for a septal haematoma.
B. Order plain nasal radiographs: Imaging does not treat the urgent diagnosis.
C. Same-day drainage of a septal haematoma with appropriate ENT care: A septal collection compromises cartilage blood supply and can cause necrosis, abscess, perforation and saddle deformity. The cosmetic fracture assessment must not delay drainage.
D. Use topical decongestants only: They cannot decompress the avascular collection.
E. Start oral antibiotics without drainage: Antibiotics cannot evacuate the collection.
What if the scenario changed?
If the septum were firm and clearly deviated rather than fluctuant, the urgent drainage pathway would not apply.
Draft Clinora educational material only; not official JCIE content, an accredited programme, or a substitute for local policy and specialist judgement.
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