Surgical Technique Modifications for the Treatment of Septal Hematoma after Septoplasty: A Case Report

Septoplasty is a commonly performed procedure to improve the nasal airflow, and septal hematoma is a recognized, but relatively rare complication associated with this procedure.Although prompt drainage is recommended, the optimal management strategies for refractory cases remain unclear.We report a case of delayed septal hematoma following septoplasty that was not adequately controlled by outpatient drainage and therefore required revision surgery under general anesthesia.A 22-year-old man underwent septoplasty with bilateral inferior turbinate reduction and posterior nasal neurectomy due to a nasal obstruction.Despite an initially uneventful postoperative course, septal swelling developed on postoperative day 10.Outpatient drainage under local anesthesia was performed.However, the hematoma recurred.Therefore, revision surgery was performed.Complete evacuation of the hematoma was achieved, followed by cauterization of the minor bleeding from the posterior septal branch of the sphenopalatine artery.A Y-shaped incision was created in the posterior septal mucosa to establish a wide drainage pathway, and transseptal suturing was performed to eliminate the dead space.No recurrence was observed postoperatively, and complete healing was confirmed at 56 days postoperatively.This case highlights the importance of adequate posterior drainage and effective septal compression in preventing the recurrence of septal hematoma following septoplasty.