• Often can be drained in the ED
• See Above - NEJM Video: Treatment of Hematoma of the Nasal Septum

Step-by-Step Instructions

• 1) Sterile preparation
• 2) Anesthestize septum with topical or atomized anesthetic, then add local anesthetic
  • Topical anesthesia: Use cotton pledgets soaked in 4% lidocaine with oxymetazoline (nasal spray vasoconstrictor to help decrease bleeding) and wait 10 min
  • Atomized: use lidocaine spray, or take 2cc of 4% lidocaine with atomizer device
  • Local: inject 1-2% lidocaine with epinephrine at the surface of the hematoma (the epinephrine will cause blanching of the mucosal surface)
• 3) Make an elliptical incision in the mucosa overlying the hematoma, with caution not to incise the cartilage
• 4) Evacuate clot with pressure +/- suction
• 5) Place small petroleum jelly based gauze onto the incision
  • Option: Can also use penrose drain or ribbon packing instead
• 6) Pack both nostrils (as in anterior epistaxis) to reapproximate the perichondrium and septal cartilage
  • Many options for epistaxis packing - e.g. ribbon gauze, tampon packing, etc.
• 7) Consider need for antibiotics for S. Aureus coverage
  • Options for MSSA coverage include: Keflex, cloxacillin, septra
• 8) Follow-up with ENT/Plastics/OMFS in 48 hours
  • Mucosa should heal within 1 week