The majority of patients present to Accident and Emergency at the time of injury: if a fracture is suspected, they will usually be offered an appointment at St John’s Hospital ENT Emergency Clinic approximately five days after the injury.
At the time of acute presentation, it is important to exclude a septal haematoma, which develops between the septal cartilage and the overlying mucoperichondrium. These need emergency treatment or septal cartilage damage can occur rapidly, potentially leading to irreversible septal destruction (requiring complex reconstruction surgery). A septal haematoma is visible as a fluctuant swelling arising from the nasal septum, usually bilateral.
If nasal manipulation is required, it should ideally be performed within two weeks of the injury (the longer the delay the decreased chance of successful outcome).
CM & IN – 28-8-26
Treatment may be unnecessary if no deformity or breathing difficulties.
Please call the ENT doctor on call at St John’s Hospital for an emergency assessment if:
- a septal haematoma is suspected
- patients present to GPs within 2 weeks of nasal injury and have nasal deviation.
If patients present to GPs more than 2 weeks post injury and there is significant deformity, there will not be enough time to arrange manipulation, and a routine ENT referral should be made via SCI Gateway
