EPISTAXIS
.
INTRODUCTION
Epistaxis :- Is bleeding from inside the
nose from any cause
Epistaxis is very common. About 10%
of the general population have had one
or more episodes. The incidence
seem to be higher during the low
humidity season.
Mostly originates in the anterior portion
of the
nasal cavity
NASAL BLOOD SUPPLY
The nose receives blood from both
the external and internal carotid
arteries.
• OPTHALMIC ARTERY
From the internal carotid blood
reached the nasal cavity through the
Posterior and Anterior Ethmoid
arteries which are branches of the
ophthalmic artery.
• Superior labial artery which is a
branch of the facial artery also
supply blood to the nasal cavity.
SPHENOPALATINE ARTERY
Sphenopalatine artery
Most of the blood supply to the nose
is how ever derived from the
sphenopalatirine artery which is a
terminal branch of the maxilary
artery which arises from the external
carotid artery.
Superior labial artery which is a
branch of the facial artery also supply
blood to the nasal cavity.
KIESSELBACH’S PLEXUS (Little’s
area)
The Kiesselbach’s plexus is a rich
anastomosis of blood vessels from
the external and internal carotid. It
is situated at the anterior aspect of
the Nasal septum. This site also
known as the little’s area is the
most common site for epistaxis.
AETIOLOGY
In about 10% of the cases the
condition remains idiopathic.
LOCAL CAUSES
• Septal varices
• Trauma
• Infections
• Septal deviation
• Septal perforation
• Foreign bodies
• Chemical irritants
• Neoplasms (e.g Angiofibroma and
Nasopharyngeal carcinoma)
• Pyogenic granuloma,
haemangiomas
• Post operative cause (septoplasty,
rhinoplasty etc)
SYSTEMIC CAUSES
• Vascular disorders
(a) e.g Rendu-Osler-Weber disease
(Hereditory Haemorrhagic
Teleangiactesia)
(b) Arteriosclerosis in Hypertension.
(c)Thrombo cytopaenia (primary
and secondary)
(d)Von willebrand’s disease.
INTRINSIC CLOTTING FACTORS
DEFICIENCY
(a) Haemophilia (Factor VIII) 80%
(b)Christmas disease (Factor x ) 13%
(c) Factor XI deficiency 6%
(d)Drugs (e.g anticoagulants)
CARDIOVASCULAR
(a) Mitral stenosis
(b)Coactation of the aorta
Due to increased systemic venous
pressure
MANAGEMENT OF EPISTAXIS
This includes
• A good history
• Thorough physical examination
• Investigation
• Treatment
Take into account the
following
(a) Degree of haemorrhage
(b)Prior history of bleeding
(c) Precipitating factors
(d)Complicating medical conditions
(e) Use of medications e.g
Anticoagulants, aspirin etc.
INVESTIGATIONS:
(a) Full bood picture + platelet count
(b)Bleeding and coagulation-Indices
(c) Para nasal sinus X-ray
(d)Chest X-ray
(e) Liver function tests
(f) Renal function tests
TREATMENT
(a) First aid
- Pinching the nose for about 5
minutes
ANTERIOR NASAL PACKING
(i) Ribbon gauze
(ii) Antibiotic ointment
(iii)Vasoconstrictor
POSTERIOR NASAL PACKING
(i) By gauze
(ii) Folley’s catheters
CAUTERIZATION
(i) Chemical cauterization by
Silver nitrate stick (superficial
cauterization
(ii) Electrocautery
- Deeper cautery in case of
recurrence after
(I) above
(iii) Laser photo cauterization
LIGATION OF BLOOD VESSELS
• Ligation of the external carotid
artery
• Clipping of the internal maxillary
artery to which the sphenopalatine
is a branch.
• Embolization of the sphenopalatine
artery.
