Septal Hematoma: A Nasal Emergency After Injury or Surgery

3 days ago

3 min read

Key takeaways

A septal hematoma is a collection of blood between the septal cartilage and its lining, usually after nasal trauma, and occasionally after nasal surgery.
The cartilage depends on that lining for its blood supply, so a hematoma can cause cartilage death within days, leading to septal perforation or a collapsed (saddle) nose.
Warning signs after a nasal injury: severe or worsening blockage on one or both sides, pain, swelling of the septum, fever.
It does not resolve on its own; it must be drained promptly by a doctor, followed by packing or splints and antibiotics.

What is a septal hematoma?

The nasal septum is made of cartilage and bone covered on both sides by a thin lining (mucoperichondrium) that carries its blood supply. When a blow to the nose ruptures small blood vessels, blood can collect between the cartilage and this lining. The body tries to clot the blood, forming something like a bruise or clot inside the septum. Unlike a bruise on the skin, it rarely drains or resorbs by itself, and it separates the cartilage from its nourishment.

Why it is urgent

Cartilage necrosis: without blood supply the cartilage can die in as little as 3 days.
Septal abscess: the trapped blood can become infected, causing fever and severe pain.
Septal perforation: loss of cartilage leaves a hole; see septal perforation repair.
Saddle nose deformity: loss of septal support collapses the bridge; see saddle nose repair.
In children, cartilage damage can disturb nasal and midface growth.
Rarely, infection can spread beyond the nose.

Causes

Nasal injury: falls, sports, fights, traffic accidents
Nasal fractures
Nasal or septal surgery (uncommon)
Bleeding disorders or blood-thinning medication increase the risk

Symptoms

Nasal bleeding after the injury
Swelling around and inside the nose
A partial change in the shape or size of the nose
More congestion than expected, often on both sides
Pain, tenderness at the tip, and sometimes fever

Inside the nose, the septum looks swollen, soft and dark red or purple, bulging from both sides.

Diagnosis

A doctor examines the inside of the nose with a light and speculum or an endoscope. A soft, compressible swelling of the septum after trauma is typical. Anyone with a nasal injury and significant blockage should be examined, even if the outside of the nose looks fine.

Treatment

Drainage: under local or general anaesthesia, a small incision is made in the lining and the blood is evacuated. A small drain may be placed.
Preventing re-accumulation: internal splints or light packing press the lining back against the cartilage.
Antibiotics reduce the risk of infection and abscess.
Follow-up: the nose is checked within 24–48 hours to ensure no re-collection.
Fracture management: nasal fractures can be reduced at the same time or later.

If cartilage has already been damaged, reconstruction with cartilage grafts may be needed later.

After rhinoplasty

Septal hematoma after rhinoplasty is uncommon, thanks to careful technique and internal splints. However, if you hit your nose during recovery and notice increasing blockage and pain, contact your surgeon immediately. See hitting your nose after rhinoplasty.

Frequently asked questions

Can a septal hematoma heal on its own?

No. It requires medical drainage.

How soon should it be treated?

As soon as possible, ideally within 24–72 hours of the injury.

Is drainage painful?

It is performed under anaesthesia; afterwards, discomfort is mild to moderate.

Can a septal hematoma happen without a broken nose?

Yes. It can occur even when the nasal bones are not fractured.

Next step

If you have had a recent nasal injury with increasing blockage, seek urgent medical care. For reconstruction after nasal trauma, contact Prof. Dr. Suleyman Tas Clinic.

About the author

Prof. Dr. Suleyman Tas is a European Board-certified plastic, reconstructive and aesthetic surgeon based in Istanbul with over 20 years of experience, author of Rhinoplasty in Practice (CRC Press) and founder of the Closed Atraumatic Rhinoplasty Course. Read verified patient reviews or book a consultation.

This article is for general information and does not replace an individual medical consultation.