Epistaxis(nosebleed)

Epistaxis
Synonyms: nasal hemorrhage, nose bleed, bosebleed, bloody
nose.

Background: nosebleed is defined as acute hemorrhage from

the nostril, nasal cavity, nasopharynx. In the majority of the cases, bleeding is in small quantities and self-limited, sometimes it can be very intense and life-threatening.

Incidence: with peak in those aged 2-10 years and 50-80 years.
No sex predilection.

Climates factor: nose bleed most common occurs

during colder month and in dry colder climates

Epistaxis
Pathophysiology:
Primary bleeding site: anterior is common. Posterior is rare Littles area is most commonly bleeding site (Kieselbach plexus) Posterior bleeding usually originate below the posterior half of the inferior turbinate or roof of the nasal cavity.

Epistaxis
Cause:
Local causes
Trauma: fracture of nasal bone Infection: viral rhinitis, acute rhinitis. Foreign bodies: Deviation of the nasal septum Atmospheric change, dry climates Tumors in nasal cavity and sinuses

Epistaxis
General Causes
hypertension and heart diseases pregnancy Acute general infection Drugs abuse Diseases of blood system

Epistaxis

Diagnostic step:

1.history: 2.localize bleeding site 3.determine causes 4.measurement of blood pressure 5.analysis of blood coagulation 6.radiograph or CT image

Epistaxis

Treatment:

Digital press: 10 minutes Cautery: AgNO3 , laser,

microwave

Hardener injection: 40% urea Nasal packing: vaseline gauze, balloon glutin sponge compressed sponge

Epistaxis
Traditional packing:
Vaseline gauze ribbon for 24~48 hours

Prevent infection of sinus with antibiotic

Epistaxis

The step of posterior nasal packing

Epistaxis
Vascular ligation
this procedure is used for uncontrolled lifethreatening epistaxis external carotid artery(ECA) often be ligated because most nosebleed site is the area supplied with the branch of ECA . Calming the patient Lowering of blood pressure Discontinuation of anticoagulation Administration of fluid expanders

Epistaxis
How to prevent rebleeding after initial bleeding has stopped

Do not pick or blow nose. Do not strain or bend down to lift anything heavy. Keep head higher than the heart. Use a humidifier during dry winter months A saline nasal spray will also moisten dry nasal membranes.

Cancer of the nose and sinus

Cancer of the nose and sinuses

General situation:

cancers of nose and sinuses occupy less than 1% of all

malignancies and about 3% of all head and neck cancer. The aetiology is unknown.

Aetiology
Definite factor: dust from hard woods, nickel
99% tumor affect the maxillary and ethmoid sinuses, only 1% tumor affect the frontal and sphenoid sinuses

Cancer of the nose and sinuses

Pathology:
80% of tumor are squmous cell cancer. 10% of tumor are adenocarcinoma or adenoid cystic carcinoma 1% of nasal tumor are melanomas. sarcomas are rare, but in our depatment, we had once treated some patients with rhabdomyosarcoma. Most of them are children recently, the malignant lymphoma in nose and sinuses often treated by ENT doctors.

Cancer of the nose and sinuses

Clincal features:

1.Squmous-cell cancer or basal-cell cancers usually affect the nasal skin. 2.Squmous-cell cancer grow faster and may metastasize to the neck at any stage. basal-cell cancers grow slowly and and then gradually spread locally, they do not metastasize. But in advance stage, they can erode the nose and adiacent cheek . 3. It is difficult to distinguish tumor origination from maxllary sinuses or ethmoid sinuses.

Tumor invading and clinical symptom

Erode orbital floor

diplopia, proptosis

invade the face enter nasal cavity

cheek bulged, numbness tears, obstruction

Bloody discharge

erode tooth and palatine invade pterygopalatine fossa

oral cavity trismus

* Invasion of nerves will cause headache, numbness in the face or palate

Cancer of nose and sinuses

Tumor of ethmoid sinus Cancer of maxillary sinus Nasal cancer

Diagnosis

biopsy and X-ray, CT, MRI confirmation

Malignant teratoma
Undifferentiated cancer

Ossifying fibroma

Treatment

Surgical excision: maxillectomy Radiotherapy: Chemotherapy Combination therapy

Malignant fibrohistocystosis