Nasal septal hematoma is the collection of blood between the cartilage or bony septum and its mucoperichondrium or mucoperiosteum. The most common symptoms in children include nasal obstruction, pain, and rhinorrhoea. Asymmetries of the septum with a bluish or reddish fluctuance suggest a hematoma. Delayed diagnosis and treatment may result in abscess formation, septal perforation and intracranial complications. Therefore, urgent surgical drainage is indicated for all nasal septal hematomas. After drainage, it is conventional, to pack both nostrils with gauze strip as in anterior epistaxis, to approximate the perichondrium to the cartilage. The drain and packing remain in place until the drainage stops for 24 h; this usually takes 2-3 days. These methods of packing the nasal cavity is associated with mouth breathing which can be very uncomfortable thus adding to the patient’s postoperative morbidity. Rather than pack the nostrils with gauze strips as in anterior epistaxis, we used a fenestrated portex endotracheal tube that just firmly fits the patient’s nasal cavity and extending from the posterior choana to about ½ inch beyond the collumela. This allowed for nasal breathing and mucus drainage into the nasopharygnx. The tube-drain/pack remained in place until the drainage stopped for 24 h. This prevented the discomfort of mouth breathing while ensuring a comfortable postoperative patient while asleep or awake.
Key words: Nasal septal hematoma, tubular nasal pack, immediate nasal breathing.
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