However, in children, due to their thicker septum and more flexible lining, nasal septal hematoma can be caused from minor nasal trauma such as simple falls, collisions with stationary objects, or minor altercations with siblings. Mechanism and pathophysiology
The exact mechanism for the formation of hematoma from nasal trauma is controversial, but thought to occur in nasal septal hematomas when there is force to the nasal cartilage. The force causes the perichondrial blood vessels to leak and rupture in the nasal septum. The cartilage in the septum is avascular and can be 2–4 mm thick. The septum gets its blood supply from the ethmoid and sphenopalatine arteries.The nasal septum is composed of cartilaginous, membranous, and bony components overlaid by mucoperichondrium and mucoperiosteum. Bleeding within the confines of the mucoperichnondrium leads to a septal hematoma, where as external bleeding from Kiesselbachs plexus results in epistaxis. The Kiesselbach plexus is located anterior inferior of the nasal septum, where the anastomosis of blood vessels is located.Normal nasal mucosa is pink and healthy appearing, without ulcerations, crusting, or bleeding. Some common, abnormal variations include septal deviations, spurs, and an enlarged, aerated middle turbinate. Pale or inflamed mucosa, purulence, nasal polyps, or a septal perforation are all common pathologic features that may or may not be combined with the abnormal variations listed above. Diagnosis
The doctor will use a nasal speculum for visualization of the nasal septum, the inferior turbinate, and a portion of the middle turbinate. The view of the nasal passage may be partially obstructed by the tools used.
Within 72 hours, the infection can form a septal abscess.Treating a septal hematoma requires it to be incised and drained to prevent avascular necrosis of the septal hyaline cartilage. This will depend on diffusion of nutrients from its attached nasal mucosa.The septum can generally heal within 1 week, without any evidence of the incision. The mucosa will appear healthy and smooth.Secondary infections can be prevented by starting the patient on an antibiotic regimen immediately after the procedure and continuing the treatment while the nasal packs are in place. If an abscess is present, a specimen of the abscess can be sent for culture to ensure that the antibiotics prescribed have provided adequate coverage. Culture-directed therapy can help avert dangerous late sequalae, including the intracranial extension of a septal abscess. If the hematoma is not promptly drained, the septal cartilage may be destroyed. In such cases, a saddle-nose deformity may develop. Prognosis
As long as the septal hematoma is treated promptly, a full recovery is common. If the condition is left untreated and develops complications such as fever, infection, or an abscess, then the nasal septal hematoma is still very treatable if seen by a doctor. If saddle nose is developed, surgery could be required. Epidemiology
Septal hematomas are rare but can effect everyone in every age group. There is no exact number  of the incidence that occur because a lot of the cases will remain undiagnosed.