Discussion

Alar hematoma refers to a blood collection between the alar cartilage and the overlying intact perichondrium [1]. Children seem to be more likely to sustain a septal nasal injury, likely due to the presence of softer septal cartilage, which is more prone to buckling [3]. Nasal alar hematoma is very uncommon and was first described in the literature in 1994 [4]. The mechanism of alar cartilage hematoma formation is nasal trauma, and it has been observed primarily in the pediatric population [4]. In the above case, the hematoma developed in the absence of any predisposing coagulopathy. In children, the nasal cartilage tends to be more vascularized and less ossified than in adults. The cartilage tissue has a weak and loosely adherent mucoperichondrium [5]. As such, children may thus be more prone to develop alar cartilage hematoma than adults [6].

Cartilage tissue is an avascular structure that acquires oxygen from the perichondrial capillaries. A developing hematoma would prevent the alar cartilage from receiving sufficient glucose and oxygen [7]. A hematoma left untreated can become infected, developing into an abscess and possibly resulting in severe complications. Such complications can range from severe aesthetic deformities to intracranial sequelae leading to death [8].

Compared to an alar hematoma, which is usually unilateral, a septal hematoma is more likely to be bilateral, especially when the trauma is severe. The process involves the rupture of submucosal vessels, which causes a collection of blood between the nasal septal cartilage and the perichondrium. If left untreated, infection of the area can occur within 72 hours, possibly leading to a septal perforation [2]. Both hematomas are vague in symptoms and require awareness of the condition and a high level of suspicion. Furthermore, urgent incision and drainage are needed in both [2].

This presentation of alar cartilage hematoma has yet to be studied, and due to the sparse number of cases, there are no proper guidelines on the management of nasal alar hematomas. Considering its close approximation to the septum and being of similar tissue quality, it stands to reason that the correct assessment and management of nasal alar hematomas are also crucial to prevent complications. Early diagnosis will reduce the risk of abscess formation and nasal deformity [3]. The patient in this case underwent hematoma evacuation within 24 hours of the injury, and subsequent monitoring revealed no discernible functional or cosmetic complications.