Hematoma and abscess of the nasal septum: causes, symptoms, diagnosis, treatment

The hematoma of the nasal septum is a limited accumulation of liquid or coagulated blood between the perichondrium (periosteum) and the cartilage (bone) or between the perichondrium (periosteum) and the mucosa due to closed nose injuries with a violation of the integrity of its vessels.

The abscess of the nasal septum is a cavity filled with pus and separated from surrounding tissues and organs by a pyogenic membrane located between the perichondrium (periosteum) and cartilage (bone) or between the perichondrium (periosteum) and the mucous membrane resulting from suppuration of the hematoma of the nasal septum or chondroperichondritis in infectious diseases (a face, a furuncle of a nose), caries of a teeth, a diabetes, etc.

ICD-10 code

J34.0 Abscess of nasal septum.

Epidemiology of hematoma and abscess of nasal septum

Accurate data on the prevalence of hematoma and abscess of the nasal septum at the present time there. This pathology is recorded in 1.1% of patients with various traumatic injuries of the nose and paranasal sinuses. Nose injuries in the structure of injuries of the facial skull range from 8 to 28%, and the structure of all bone fractures ranges from 12 to 43%.

[1], [2], [3]

Causes of hematoma and abscess of nasal septum

The immediate cause of hematoma is a nasal septum injury (with bruises, external nose fractures, surgical interventions on the nasal septum), leading to damage to the vessels of the perichondrium and hemorrhage. Predisposing factors - disorders of the coagulating system of blood, acute infectious diseases of the upper respiratory tract. In these cases, nasal septal hematoma can occur even with minor injury to the nose.

When the neoporozhnennoy is infected in a timely manner the hematoma forms an abscess of the septum of the nose. A characteristic microflora in such cases is staphylococcus aureus (Staphylococcus aureus, epidermidis, saprophyticus), as well as beta-hemolytic group A streptococcus.

[4], [5], [6], [7], [8]

Pathogenesis of hematoma and abscess of nasal septum

The leading pathogenetic mechanism is the rupture of the vessels of the inner layer of perichondria with subsequent hemorrhage. A significant role in the onset of hematoma of the septum also includes diseases accompanied by fullness of the nasal mucosa, a violation of blood clotting processes, an increase in the permeability of the vascular wall (acute and chronic rhinitis, hypertension and symptomatic arterial hypertension, circulatory disorders of various genesis with increased arterial pressure in the vessels of the head and neck, coagulopathy, hemorrhagic diathesis, hypo- and avitaminosis, etc.).

The peculiarity of the nasal septum hematoma is the inflammatory reaction that rapidly develops in response to damage, with the formation of biologically active metabolites, the causes of secondary alteration of tissues and inhibition of the activity of various parts of the immune system. Violation of the barrier function of the nasal mucosa promotes the transepithelial migration of bacteria growing in the nasal cavity and the infection of extravasate.

Less often abscess of the nasal septum is a consequence of the spread of infection from the focus of inflammation with periodontitis, furuncle of the nose. Adverse effects on the frequency of onset, course and prognosis of the abscess of the septum of the nose are exerted by endocrine diseases, primarily diabetes mellitus: hypovitaminosis, inadequate nutrition, digestive diseases, immunodeficiency states, etc.

Symptoms of hematoma and abscess of nasal septum

The most common symptom of nasal septal hematoma is the difficulty of nasal breathing, which develops soon after a nose trauma. Attachment of complaints of headache, malaise, increased body temperature indicate the formation of an abscess.

When analyzing the clinical manifestations of nasal septum abscesses, one should keep in mind the high probability of involving quadrangular cartilage in the process, the rapid development of chondroperichondritis with the formation of perforation of the nasal septum, deformation of the nasal bridge. In addition, the risk of developing severe septic complications should be considered. To a large extent, it is associated with the peculiarities of the outflow of venous blood from this anatomical zone, which is carried through the anterior facial and orbital veins into the cavernous sinus. This circumstance creates real prerequisites for the spread of the purulent-inflammatory process not only by contact in the cranial direction to the roof of the nose and the base of the skull, but also generalization of the infection with hematogenous formation of septic thrombosis of the cavernous sinus. In this case, an infectious syndrome develops with high fever, chills, sweating, and typical cases are discirculatory disorders - pastovness, swelling of the peri-ocular area, injection of conjunctival veins, chemosis, exophthalmus, stagnant changes in the fundus.

Classification of hematoma and abscess of nasal septum

Clear classification of the hematoma (abscess) of the nasal septum is not present. In everyday clinical practice, one or two-sided hematoma is usually distinguished. With abscess of the nasal septum, attention is drawn to the presence of symptoms of purulent-septic complications, deformation of the external nose due to melting of quadrangular cartilage. The listed features of the pathological process are taken into account in determining the scope and nature of treatment measures and are reflected in the diagnosis.

[9], [10], [11]

Diagnosis of hematoma and abscess of nasal septum

The recognition of hematoma and (or) abscess of the nasal septum is based on the analysis of patient complaints, anamnestic data and data examination of the nasal cavity.

Physical examination

With anterior rhinoscopy, a thickening of the septum of the nose from one or both sides of the reddish-cyanotic color is determined. In these cases, the nasal cavity is poor or inaccessible for inspection. In some cases, pillow-like protrusions can be seen already when the tip of the nose is raised. In the case of bilateral localization of the hematoma, the septum acquires an F-shape.

Laboratory research

In the study of peripheral blood in patients with abscess of the nasal septum, neutrophilic leukocytosis and an increase in ESR are detected.

Instrumental research

In some situations, in order to recognize the hematoma (abscess), it is necessary to remove the exudate, blood from the nasal cavity with the help of the electric suction device, to resort to the bulging of the bulging with a button probe or a cotton towel, in the case of a nasal septum hematoma determine the fluctuation. A reliable sign is the detection of blood in the puncture of swelling and aspiration of its contents: when suppuration of the hematoma get purulent exudate.

Indications for consultation of other specialists

The complicated course of abscess of the nasal septum, the presence of pathogenetically associated with the main diseases requiring special treatment (for example, diabetes mellitus) in the patient is considered a testimony to the consultation of other specialists (neurologist, neurosurgeon, ophthalmologist, dentist, endocrinologist, etc.). When a hematoma of the nasal septum occurs in children, a hematologist should be consulted to exclude blood diseases.

[12], [13], [14], [15]

Treatment of hematoma and abscess of nasal septum

Objectives of treatment of hematoma and nasal septal abscess

Regress local inflammatory changes, normalization of the general condition of the patient, rehabilitation of work capacity.

Drug treatment of hematoma and abscess of nasal septum

With an abscess of the nasal septum, the opening and draining of the purulent cavity is complemented by systemic antibiotic therapy. The drugs of choice in these cases are cephalexin, oxacillin; alternative - cefazolinum, zmoksitsillin + klavulinovann acid, vincomycin, linezolid.

Surgical treatment of hematoma and abscess of nasal septum

The hematoma of the nasal septum is emptied under local or general anesthesia, by cutting the mucous membrane with a scalpel. After evacuation of liquid blood and clots into the formed cavity, drainage (a strip of glove rubber) is introduced, and in both halves of the nasal cavity - tampons, which are left for 24-48 hours and depending on the specific clinical situation.

You can not resort to tamponade if the nasal septum after opening the hematoma can be stitched with a continuous U-shaped seam.

With a small unilateral hematoma, a puncture is performed followed by a tamponade of the corresponding half of the nose.

When the hematoma (abscess) is combined with post-traumatic deformation of quadrangular cartilage and (or) bone sections of the nasal septum, opening and draining of the hematoma (abscess) with simultaneous reconstruction of the nasal septum in an acute period is shown.

Further management

In the case of uncomplicated course of the disease with hematoma of the nasal septum, approximate terms of incapacity for work are 5-7 days, with abscess - 7-10. With the development of septic complications, the hospitalization period can reach 20 days or more.

Recommendations for patients should contain information on the advisability of consulting an otorhinolaryngologist after a nasal injury, the need to fulfill a doctor's prescription for the treatment of hematoma (abscess) of the nasal septum.

Prevention of hematoma and abscess of the nasal septum

Primary prevention of hematoma (abscess) of the nasal septum is to prevent injuries (microtrauma) of the nose and mucous membrane of the nasal septum. An important role is played by timely treatment of acute infectious diseases of the upper respiratory tract, as well as sanitary and hygienic measures aimed at reducing the concentration of industrial aerosols and dust in the atmosphere of industrial and domestic premises.

Secondary prevention is a system of measures aimed at preventing hematoma (abscess) of the nose septum in people at risk - patients with congenital and acquired hemorrhagic diseases, diabetes mellitus, immunodeficiency states of various genesis. Of great importance are periodic medical examinations of such patients, the level of their awareness of the causes and clinical manifestations of hematoma (abscess) of the nasal septum, possible complications of this disease, timely sanitation of foci of infection (caries, tonsils, paranasal sinuses, etc.), correction of existing systemic disorders .

Forecast of hematoma and abscess of nasal septum

The prognosis with timely opening of the nasal septal hematoma and evacuation of the contents is favorable; when attaching a secondary infection and forming an abscess, melting of the quadrangular cartilage may be possible with the formation of a stable deformation of the external nose (nasal occlusion of the dorsum).

With the spread of the purulent-inflammatory process, the onset of septic complications, the presence of concomitant diseases, the prognosis depends on the severity of the condition, the timeliness and adequacy of the therapeutic measures, the degree of compensation of the concomitant pathology.

[16], [17], [18], [19], [20], [21], [22]