Epistaxis

Epistaxis – Greek for

nosebleed
Carl Michel 1871, James Little 1879,
Wilhelm Kiesselbach – nasal septum’s
anterior plexus.
Americans 5-14% - each year
10% - otalaryngologist
 Blood supply of the nose
 a carotid int – a ophthalmica
 a ethmoidalis ant et post
 a carotid ext – a maxillaris int
 a sphenopalatina

Keisselbachi’s plexus – anterior bleeds

Woodruff’s plexus – posterior bleeds
 Etiology
1. Mucosol Disruption
* Desiccation
* Trauma
* Infection
* Spontaneous rupture
* Chemical irritation
* Foreign body
 Etiology (continue)
2. Vascular abnormalities
* Varies
* Hereditary hemorrhagic
telangiectasia
* Metabolic and dietary disorders
 Etiology (continue)

3. Intravascular Disorders
* Hypertension
* Platelet disorders
* Coagulation disorders
* Kidney and liver disease
 Etiology (continue)

4. Tumors
* Benign : hemangioma, papilloma,
givenile angiofibroma
* Malignant: squamous cell
carcinoma adenoid cystic carcinoma
 Treatment
Non surgical
* packing ant and posterior
* cauterization dipolor 80-90 %
* vasoconstrictors
* lidocaine with epinephrine and cocaine,
dicaine
Ant Nasal tampon packing usually 3 days
Post. Nasal packing 3-5 days
 Treatment (continue)
Surgical
* a maxillary ligation 1928 Henry
* a ethmoidalis ligation
* a carotid ext ligation 1869 Pilz
* transnasal endoscopia sphenopalatine
ligation complication 25-30%