Superficial Traumatic Injuries of the Nasal Mucosa

Superficial traumatic injuries of the nasal mucosa can be caused by a variety of events including blunt trauma, chemical or thermal burns, or iatrogenic trauma caused by endonasal sinus surgery, endoscopic sinus surgeries, and trauma from nasoseptal flap or turbinoplasty.

Traumatic mucosal lesions are generally classified according to their depth, as follows:

Superficial trauma: The lesions caused are restricted to the nasal mucosa and do not involve the underlying support structures.
Middle depth trauma: The lesions involve the nasal mucosa and the underlying support structures (septal mucoperiosteum, for example).
Deep trauma: The lesions involve the nasal mucosa, the underlying support structures and the supporting bony structures.

The clinical presentation of superficial nasal mucosal trauma depends on the type of trauma. Blunt trauma generally results in ecchymosis, edema, hemorrhage or laceration. Small chemical or thermal burns often lead to erythema, edema, and pain. Iatrogenic mucosal trauma can range from desquamation, erythema, edema, and hemorrhage to ulceration and necrosis. The primary goal of treatment is to reduce the symptoms, which usually resolves spontaneously.

Treatment of superficial traumatic injury of the nasal mucosa may be symptomatic. Systemic NSAIDs may be used for relief of pain. Topical antibiotic ointment can reduce the risk of secondary infection. Topical anesthetic ointment can be effective for reducing nasal congestion caused by edema. Decongestants, lubricants, and vasoconstrictors can provide additional relief. In cases where there is necrosis, surgical debridement may be required.

It can be difficult to differentiate superficial nasal mucosal trauma from other conditions with similar presentation such as rhinosinusitis and nasal polyp disease. Thus it is important to perform a thorough physical examination and take a detailed history in order to rule out these other conditions. When in doubt, referral to an otolaryngologist is recommended for diagnosis and proper management.