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Objectives To determine the time from initial injury to diagnosis of nasal septal hematoma (NSH). Additional objectives included determining number of medical evaluations prior to diagnosis and long-term complications. Methods A retrospective chart review was performed on all patients diagnosed with NSH at a tertiary pediatric hospital between January 1, 2003 and April 1, 2019 were identified. Time to diagnosis was defined as time between initial trauma to date of diagnosis. Number of evaluations was defined as all medical evaluations prior to diagnosis. Results Of 2762 charts that were reviewed, 13 patients with NSH were identified. Of those, 92% were male and trauma was the cause in 85% of patients. Median time to diagnosis was 7 days (0–21 days), with an average of 2.2 evaluations (1–4 evaluations). Settings where diagnosis were missed included EDs (N = 9, 82%), primary care (N = 6, 55%), urgent care (N = 1, 9%) and otolaryngology clinic (N = 2, 18%). Four patients (31%) were evaluated by an otolaryngologist in the ED. The median time to otolaryngology outpatient visit was 7.5 days. In five patients (46%), septal hematomas were missed in multiple clinical settings. Seven patients (54%) experienced complications, including saddle nose deformity (N = 3, 23%). Conclusions NSH is a rare but serious emergency. To avoid multiple visits and delay in diagnosis, additional education and awareness is needed for providers who evaluate these patients. Early diagnosis will reduce the risk of abscess formation and saddle nose deformity.

Summary The recognition of the nasal septal abscess is traced back to 1810 when Cloquet healed an abscess by drainage. This therapy does not prevent the saddle nose deformity and its functional problems in many cases. Since 1963 the immediate reconstruction of the destroyed septum in the acute phase of the septal abscess by means of homologous cartilage has proved to prevent long-term effects of the abscess especially in the growing nose. This is underlined by some of our own long-term results and histological findings. Finally, some new pathogenetic aspects are discussed based on histological and enzymatic findings of the human septal cartilage.