EPISTAXIS

“BLEEDING FROM INSIDE THE NOSE”

 PRESENTS AS AN EMERGENCY

 SEEN IN ALL AGE GROUPS

 IT IS A SIGN NOT A DISEASE

 BLOOD SUPPLY OF NOSE

 LITTLE’S AREA : Situated in the anterior inferior

part of the nasal septum, just above vestibule.
 Usual site of epistaxis in children and young adults.
 Formed by four arteries
1. Anterioethmoidal
2. Septal branch of superior labial
3. Septal branch of sphenopalatine
4. Greater palatine
 Anastomoses form kesselbach’s plexus
 BLOOD SUPPLY OF NOSE

 RETROCOLUMELLAR VEIN : Vein runs

vertically downwards behind the columella, crosses
the floor of the nose and joins venous plexus on the
lateral nasal wall.
 common site of venous bleeding in young adults

 WOODRUFF’S PLEXUS : Plexus of veins situated

inferior to posterior end of inferior turbinate.
 Site of posterior epistaxis in adults
 EPISTAXIS

 IT IS DIVED INTO :

1. LOCAL (IN NOSE OR NASOPHARYNX)

2. GENERAL
3. IDIOPATHIC
 1. LOCAL CAUSES

 A: NOSE
 Trauma: nose picking is most common
 Atmospheric changes
 Infections
 Foreign bodies
 Neoplasms of nose and paranasal sinuses
 DNS

 B: NASOPHARYNX
 Juvenile angiofibroma
 Adenoiditis
 Malignant tumors
 2. GENERAL CAUSES

 CVS (hypertension, arteriosclerosis etc)

 Bleeding disorders
 Kidney diseases
 Infections
 Liver diseases (hepatic cirrhosis)
 Drugs (salicylates and other analgesics)
 Vicarious menstruation
 SITES OF EPISTAXIS

 Little’s area: most common

 Above the level of middle turbinate (perforation of
ant and post ethmoidal vessels)
 Below the level of middle turbinate (from branches
of sphenopalatine)
 Posterior part of nasal cavity
 Diffuse
 Nasopharynx
 CLASSIFICATION OF EPISTAXIS

1. Anterior Epistaxis: when blood flows out from

the front of the nose with the patient in sitting
position

2. Posterior Epistaxis: blood flows back into the

throat.
CLASSIFICATION OF EPISTAXIS
 MANAGEMENT

A. FirstAid :
 Pinching the nose
 Trotters method (patient is made to sit, leaning a little
forward over basin to spit any blood and breathe quietly
from the mouth)
 Cold compression ( cause vasoconstriction)
B. Cauterization :
 Bleeding point is cauterized with bead of silver nitrate or
coagulated with electrocautery
C. Anterior nasal packing
D. Posterior nasal packing
E. ligation of vessel (external carotid, maxillary arteries and
ethmoidal arteries)
F. embolization
 GENERAL MEASURES IN EPISTAXIS

 Make patient sit up with a back rest and record any blood loss
taking place
 Reassure patient
 Keep check on pulse, BP and respiration
 Maintain haemodynamics
 Intermittent oxygen
 Antibiotics (to prevent sinusitis if pack is to be kept beyond 24
hours)
 Investigate and treat underlying cause.

 Hereditary haemorrhagic telangiectasia: occurs on anterior

part of nasal septum. Recurrent bleeding. Treated with argon,
KTP, or Nd: YAG laser