EPISTAXISEPISTAXIS
IntroductionIntroduction
Epistaxis is a Latin word means bleedingEpistaxis is a Latin word means bleeding
from the nose.fr...
• The nasal fossa generally is
supplied by branches of:
• External Carotid Artery
-Sphenopalatine artery
-Greater palatine...
Arterial supply of nasal cavityArterial supply of nasal cavity
Vascular supply of the nasal cavity
Anatomy of the Nasal Cavity
and Vasculature
Kiesselbach’s
Plexus/Little’s Area:
-Sphenopalatine A
- -Greater
Palatine A
-Superior Labial A
-Anterior Ethmoid (Opth)
Wo...
Sites of bleedingSites of bleeding
1.Nasal septum :1.Nasal septum :
75%-90%75%-90%
Little’s area ‘’Kiesselbach’s’’plexus.L...
EtiologyEtiology
Local factorsLocal factors
-congenital (meningocele)-congenital (meningocele)
-acquired-acquired

Idiopa...
EtiologyEtiology
Systemic factorsSystemic factors
1.Hypertension ,1.Hypertension , not cause epistaxis.not cause epistaxis...
Nasal Fracture with Septal Hematoma
Etiology and AgeEtiology and Age
Children—foreign body, nose pickingChildren—foreign body, nose picking
Adults—trauma, idi...
Management of EpistaxisManagement of Epistaxis
HistoryHistory::
--quantity of blood lossquantity of blood loss
--side and ...
Immediate managementImmediate management
Pressure on the nostrilsPressure on the nostrils
(breath through the mouth and(br...
Epistaxis (active bleedingEpistaxis (active bleeding((
Admission, IV line , blood
group and cross match,
monitor pulse ,BP...
EpistaxisEpistaxis
Coagulopathy
Family history +ve
Osler Weber disease
Laser cautery Septodermoplasty
Recent bleeding
Blee...
Non-surgical treatmentsNon-surgical treatments
General adviseGeneral advise
Avoidance of nose picking/blowingAvoidance of ...
Elderly and those with other chronicElderly and those with other chronic
diseases may need to be admitted todiseases may n...
Indications for surgery/embolizationIndications for surgery/embolization
The patient who continues to bleed everyThe patie...
Surgical treatmentSurgical treatment
Transmaxillary IMA ligationTransmaxillary IMA ligation
Intraoral IMA ligationIntraora...
SMRSMR
When bleeding behind prominent spurWhen bleeding behind prominent spur
To improve access for cauteryTo improve acce...
Anterior and posterior nasal
packing
Balloons
close
Thank youThank you
E.N.T 5th year, 2nd lecture/part one (Dr. Yousif Chalabi)
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E.N.T 5th year, 2nd lecture/part one (Dr. Yousif Chalabi)

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The lecture has been given on Nov. 29th, 2010 by Dr. Yousif Chalabi.

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E.N.T 5th year, 2nd lecture/part one (Dr. Yousif Chalabi)

  1. 1. EPISTAXISEPISTAXIS
  2. 2. IntroductionIntroduction Epistaxis is a Latin word means bleedingEpistaxis is a Latin word means bleeding from the nose.from the nose. Epistaxis is a common problem and affectsEpistaxis is a common problem and affects all age groups , although it is common inall age groups , although it is common in both extremes of life, 5-10% of theboth extremes of life, 5-10% of the population experience an episode ofpopulation experience an episode of epistaxis each year. 10% of those will see aepistaxis each year. 10% of those will see a physician. 1% of those seeking medicalphysician. 1% of those seeking medical care will need a specialist.care will need a specialist.
  3. 3. • The nasal fossa generally is supplied by branches of: • External Carotid Artery -Sphenopalatine artery -Greater palatine artery - Superior Labial artery - - • Internal Carotid Artery -Anterior Ethmoid artery -Posterior Ethmoid artery Of maxillary artery Of facial artery Of ophthalmic artery
  4. 4. Arterial supply of nasal cavityArterial supply of nasal cavity
  5. 5. Vascular supply of the nasal cavity
  6. 6. Anatomy of the Nasal Cavity and Vasculature
  7. 7. Kiesselbach’s Plexus/Little’s Area: -Sphenopalatine A - -Greater Palatine A -Superior Labial A -Anterior Ethmoid (Opth) Woodruff’s Plexus: -Pharyngeal & Post. Nasal branches of
  8. 8. Sites of bleedingSites of bleeding 1.Nasal septum :1.Nasal septum : 75%-90%75%-90% Little’s area ‘’Kiesselbach’s’’plexus.Little’s area ‘’Kiesselbach’s’’plexus. often behind a spuroften behind a spur ‘bleeding polypus’ (an‘bleeding polypus’ (an inflammatory granuloma) .inflammatory granuloma) . 2.Inferior turbinate and nasal floor .2.Inferior turbinate and nasal floor . 3.Above the middle turbinate.3.Above the middle turbinate. anterior ethmoidal vessels, usually in hypertension.anterior ethmoidal vessels, usually in hypertension. 4.The middle meatus.4.The middle meatus. 5.sinuses.5.sinuses.
  9. 9. EtiologyEtiology Local factorsLocal factors -congenital (meningocele)-congenital (meningocele) -acquired-acquired  IdiopathicIdiopathic  Trauma -F.B, facial trauma, iatrogenicTrauma -F.B, facial trauma, iatrogenic  Infectious/InflammatoryInfectious/Inflammatory  Neoplasm (benign , malignant)Neoplasm (benign , malignant)  Drug induced (rhinitis medica mentosa,local)Drug induced (rhinitis medica mentosa,local)  Inhalant (tobacco,wood dust)Inhalant (tobacco,wood dust)  DessicationDessication
  10. 10. EtiologyEtiology Systemic factorsSystemic factors 1.Hypertension ,1.Hypertension , not cause epistaxis.not cause epistaxis. 2.Raised venous pressure2.Raised venous pressure , retrocolumelar vein., retrocolumelar vein. 3.Bleeding disorder:3.Bleeding disorder: -coagulopathy (haemophilia ,Christmas disease…).-coagulopathy (haemophilia ,Christmas disease…). -platelet disorder-platelet disorder -blood vessel disorder-blood vessel disorder -hyper fibrinolysis-hyper fibrinolysis 4. Drugs4. Drugs (aspirin,NSAIDs,methotrexate,immunosupressive).(aspirin,NSAIDs,methotrexate,immunosupressive). 5.Neoplasm.5.Neoplasm. 6.Inflammatory disorder (SLE)6.Inflammatory disorder (SLE) 7.Others (liver failure, hypothyroidism)7.Others (liver failure, hypothyroidism)
  11. 11. Nasal Fracture with Septal Hematoma
  12. 12. Etiology and AgeEtiology and Age Children—foreign body, nose pickingChildren—foreign body, nose picking Adults—trauma, idiopathicAdults—trauma, idiopathic Middle age—tumorsMiddle age—tumors Old age--hypertensionOld age--hypertension
  13. 13. Management of EpistaxisManagement of Epistaxis HistoryHistory:: --quantity of blood lossquantity of blood loss --side and site of bleedingside and site of bleeding --durationduration --co morbiditiesco morbidities --family historyfamily history ExaminationExamination:: locallocal --anterior and posterior rhinoscopyanterior and posterior rhinoscopy --flexible and rigid nasoendoscopyflexible and rigid nasoendoscopy generalgeneral --vital sign , general examination , systemicvital sign , general examination , systemic Investigation( CBC, Coagulation studies,Investigation( CBC, Coagulation studies, Blood group and cross matchBlood group and cross match(( Treatment ( initial , non surgical , surgicalTreatment ( initial , non surgical , surgical((
  14. 14. Immediate managementImmediate management Pressure on the nostrilsPressure on the nostrils (breath through the mouth and(breath through the mouth and head leant forward)head leant forward) Ice or cold pack (to bridge ofIce or cold pack (to bridge of nose and roof of mouth)nose and roof of mouth) mild sedativesmild sedatives
  15. 15. Epistaxis (active bleedingEpistaxis (active bleeding(( Admission, IV line , blood group and cross match, monitor pulse ,BP. Consider blood transfusion .Treat primary cause . Identify site of bleeding (anterior, posterior, unclear) Nasal cautery after cocainization successful Naseptin General advice unsuccessful Nasal packing (2-5)days Anterior ,posterior, both Still bleeding Surgical intervention Remove pack Ephedrine drop, cautery Still bleedingSurgical intervention
  16. 16. EpistaxisEpistaxis Coagulopathy Family history +ve Osler Weber disease Laser cautery Septodermoplasty Recent bleeding Bleeding site identified Ant.Rhinoscopy Nasal cautery after cocainization (L.A.) Advise and Topical care (naseptin cream) monitoring underlying cause Previous treatmentRecurrent Nasal cautery (G.A.)
  17. 17. Non-surgical treatmentsNon-surgical treatments General adviseGeneral advise Avoidance of nose picking/blowingAvoidance of nose picking/blowing Sneeze with mouth openSneeze with mouth open Avoid strainingAvoid straining
  18. 18. Elderly and those with other chronicElderly and those with other chronic diseases may need to be admitted todiseases may need to be admitted to the ICUthe ICU Continuous cardiopulmonary monitoringContinuous cardiopulmonary monitoring AntibioticsAntibiotics Oxygen supplementation may beOxygen supplementation may be neededneeded Mild sedation/analgesiaMild sedation/analgesia IVFIVF
  19. 19. Indications for surgery/embolizationIndications for surgery/embolization The patient who continues to bleed everyThe patient who continues to bleed every time the pack is removed or the bleedingtime the pack is removed or the bleeding continue with the pack in situ ,will generallycontinue with the pack in situ ,will generally have to be transfused. if severe bleeding orhave to be transfused. if severe bleeding or over 4-5 days bleeding has not stopped,over 4-5 days bleeding has not stopped, surgical intervention should be considered.surgical intervention should be considered. Posterior bleed vs. failed medicalPosterior bleed vs. failed medical management after >72hrsmanagement after >72hrs Nasal anomaly precluding packingNasal anomaly precluding packing
  20. 20. Surgical treatmentSurgical treatment Transmaxillary IMA ligationTransmaxillary IMA ligation Intraoral IMA ligationIntraoral IMA ligation Transnasal Sphenopalatine ligationTransnasal Sphenopalatine ligation External carotid artery ligationExternal carotid artery ligation Anterior/Posterior Ethmoidal ligationAnterior/Posterior Ethmoidal ligation Other method of treatmentOther method of treatment
  21. 21. SMRSMR When bleeding behind prominent spurWhen bleeding behind prominent spur To improve access for cauteryTo improve access for cautery To interrupt blood supply from little’sTo interrupt blood supply from little’s area ,hemorrhagic nodulearea ,hemorrhagic nodule
  22. 22. Anterior and posterior nasal packing
  23. 23. Balloons close
  24. 24. Thank youThank you

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