Epistaxis (nosebleed) is one of the most common ear, nose, and throat (ENT) emergencies that present to the emergency room or primary care. There are two types of nosebleeds: anterior (more common), and posterior (less common, but more likely to require medical attention).

1. EPISTAXIS

2. BLOOD SUPPLY OF NASAL
SEPTUM
_Supplied by 5 arteries
ICA
↓
Ophthalmic artery
↓ ↓
Anterior Posterior
Ethmoidal A. Ethmoidal A.
ECA → Facial A. → Superior labial
A.
↓
Interior maxillary A.
↓ ↓

3. POSTERIOR EPISTAXIS
Posterior nosebleed
1. Most common site – Woodruff’s plexus
2. It is a venous plexus ( vein anastomosis)
3. But supplied by Artery – Sphenopalatine A. + Posterior pharyngeal A.
4. Present on lateral wall
5. Present on posterior inferior aspects of lateral wall
6. Most common cause – idiopathic (Unknown cause)
7. HTN (Hypertension) – is not a cause
8. 3 causative factor → can cause posterior Epistaxis
• Alcohol intake ( in last 24 hrs)
• Season – Winter/Autumn
• NSAID‘S use

4. Management of Posterior
Epistaxis

5. ENDOSCOPIC ELECTROCAUTERY
Treatment of choice for posterior
Epistaxis
If due to some reason bleeding point is not
visible
or
ENT surgeon (not available)

6. ANTERIOR
NASAL PACKING
Bilateral nasal packing
(Because to give pressure on both ant. &
post. Side)
If bleeding doesn’t stop then we assume it
is a posterior nasal epistaxis

7. POSTERIOR
NASAL PACKING
With the help of Foley’s catheter
1. Easy packing
2. Under local anesthesia
3. Under emergency conditions
If bleeding doesn’t stop then....

8. THEN WE DO CLASSICAL
POSTERIOR NASAL PACKING
Bilateral nasal packing

9. EPISTAXIS CATHETER
This can be use for Anterior or posterior or both
epistaxis
Generally this pack remain in between 48-72 hrs.
If bleeding doesn’t stop then......

10. ARTERY
LIGATION
Endoscopic Splenopalatine Artery
ligation (ESPAL)
If bleeding doesn’t stop
Or
We can’t locate the Splenopalatine artery due to
excessive bleeding then.....

11. IMA
(INTERNAL MAXILLARY
ARTERY) LIGATION
Caldwell Luc operation
If we are not able to ligate IMA due
to tumor or some other reason
Then we can ligate External
Carotid Artery( in the neck region
away from nose)
Remember – ICA is never ligated

12. ANTERIOR
EPISTAXIS
Anterior Nosebleed
KIESSELBACH’S PLEXUS
LITTLE’S AREA
•LEGS "
L - superior Labial artery
•E - anterior Ethmoidal artery
•G - Greater palatine artery
•S - Sphenopalatine artery
The four arteries anastamose at Little's area to form a
vascular plexus called Kiesselbach's plexus.

13. • Formed by 4 branches anastomosis
• Arterial plexus
1. Posterior Ethmoidal artery does not contribute
2. M/C Site of Epistaxis ( Nasal bleeding)
3. Anterior Epistaxis present from Little’s area /
Kiesselbach’s plexus
4. Present on medial wall
5. Anterior inferior aspect of septum/medial wall
Most common cause of Epistaxis – Nose Picking

14. MANAGEMENT

15. Trotter's Method
• Sit down and put your head outward
/downward
• Pinch nose with thumb & index finger
for 3-5 minutes

16. Under local anesthesia