a 9-month - old infant came with a history of repeated attacks of cyanosis , relieved by crying with tenderness at the tip of the nose by mother . mother also gave a history that the infant was not able to take breast feeds continuously . on further questioning , she gave a history of fall 1-week back with no history of nasal bleed . on examination , child had diffuse swelling on either side of the septum with minimal tenderness . after drainage , we did not want to pack the nose completely as the infant can go for cyanosis . we packed the nose with 4 mm internal diameter endotracheal tube as tubular pack on one side [ figure 1 ] . endotracheal tube was cut measuring the size of the floor of the nose extending from the posterior choana to half inch beyond the columella . the potential muco perchondreal space was totally obliterated maintaining the nasal patency [ figure 2 ] . child is on regular follow - up for the past year till this date with no other complaints . 4 mm internal diameter endotracheal tube which was used as tubular pack the infant with the tubular pack supplementary oxygen via the tubular pack the most common cause of septal hematoma is nasal trauma . in a study in nigeria the majority of the cases ( 65.6% ) were of unknown cause and were , therefore , grouped as spontaneous hematoma whereas 30.4% were due to trauma . trauma was more common in patients below the age of 15 years while spontaneous hematoma was common in patients above that age . the buckling force pulls the perichondrium from the cartilage tearing the submucosal blood vessels resulting in stagnant blood . if not drained immediately the perichondrium stripped off the cartilage deprives the cartilage of its nutrition leading to necrosis of cartilage . direct spread of infection via emissary vein can cause cavernous sinus thrombosis and a high mortality . surgical drainage is made by incising over the area of greatest fluctuation without incising the cartilage . after evacuating the blood , a strip of mucoperichondrium is excised to prevent early closure of the incision . nasal package is kept on both sides tightly to obliterate the potential space and give support to the septal cartilage . this pack can cause a lot of discomfort postoperatively due to mouth breathing and dryness of mouth . but this also makes infants obligate nasal breathers , and any nasal obstruction can cause serious respiratory obstruction resulting in cyanosis . in our case , the infant was very comfortably breathing through the nose as the tubular pack helped in maintaining the patency of nose whether asleep or awake . all cases of septal hematoma require urgent incision and drainage to prevent cosmetic deformities and dreadful complications . postoperative packing should be done , which cause more discomfort to the patients particularly infants who are obligatory nasal breathers . our idea of using tubular pack in postoperative period is a patient friendly alternate for conservative nasal pack . the child was very comfortable in postoperative period with normal nasal breathing and on follow - up till date with no recurrence .
nasal septal hematoma is a collection of blood between the cartilage or bone and mucoperichondrium or mucoperiosteum of the nose . 
 this condition requires immediate surgical drainage to prevent complications . 
 all patients need nasal packing postoperatively to prevent recurrence . 
 this causes a lot of discomforts due to mouth breathing more in infants who are obligatory nose breathers . 
 they can go for cyanosis in the postoperative period . here , we discuss the case report of an infant who had tubular nasal pack with endotracheal tube postoperatively to maintain the patency of nose .