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Year: 2013  Vol. 17   Num. Suppl. 1  - Print:
LATE DIAGNOSIS OF A SEPTAL HEMATOMA
Author(s):
Paulo Tinoco, Aline Araujo Saraiva, Lara Bonani De Almeida Brito, Marina Bandoli De Oliveira Tinoco, Saulo Bandoli De Oliveira Tinoco, Vania Lcia Carrara Lacerda
Abstract:

Purpose: To report a case of septal hematoma with a satisfactory outcome. CASE REPORT: A white male child, 6 years of age, visited the clinic 15 days ago. He presented with nasal obstruction, epistaxis, and a nodular lesion in the septal region. Initially, he had been treated for allergic rhinitis, and subsequently received treatment with a nasal vasoconstrictor and additional collagenase at another clinic without improvement. Ectoscopy revealed the presence of a node, soft in consistency, moveable, reddish in coloration, painful with palpation of the bilateral nasal septum, and larger in the right nostril. Computed tomography of the paranasal sinuses revealed a cystic lesion in the right nasal cavity. Surgical drainage was performed with the placement of a Penrose drain. The patient recovered satisfactorily after 1 week of treatment. CONCLUSION: Nasal septal hematoma is a collection of blood between the bone or cartilage of the nasal septum and the mucoperiosteum or mucoperichondrium. It is considered an emergency situation in otolaryngology, since delayed diagnosis and treatment can lead to aesthetic alterations related to local absorption of necrotic septal cartilage, as well as intracranial complications such as subarachnoid empyema, brain abscess, and meningitis. We identified nasal surgery, facial trauma, and a rarely spontaneous appearance among the triggering factors. The diagnosis is essentially clinical, noting nasal obstruction, pain, and location. Physical examination shows a bulging septum occluding one or both nostrils with the presence of reddish swelling. Complementary tests are important in cases involving complications. The treatment involves surgical drainage with the placement of a Penrose drain. The patient showed satisfactory progress despite the late diagnosis, and is receiving outpatient treatment.

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