Although nasal injury is common-place in childhood, nasal septal trauma often is neglected and frequently goes undiagnosed until complications ensue. Only a complete intranasal examination in all cases of nasal trauma will detect intranasal fractures, dislocations, lacerations, hematomas, and abscess formation. Untreated, these septal and associated injuries can lead to considerable functional (nasal respiratory) and cosmetic (external) abnormalities. We report a case to illustrate the destructive sequelae of a "minor" nasal injury. Treatment may require formal surgical exploration with hematoma evacuation, reconstruction of the septal skeletal structures, and repair of lacerations of the intranasal mucosa. We review the management of cartilage resorption secondary to hematoma or abscess formation. A technique for replacing the caudal end of the septum is discussed and illustrated.