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Dr.ASHLY ALEXANDER
DEPT OF ENT
GMC,BHOPAL
“ Acute Hemorrhage from the Nostril,
Nasal Cavity or Nasopharynx”
Vascular anatomy of the nose
External Carotid Artery Internal Carotid
FacialArtery Artery
Superior Labial Anterior Ethmoidal
Lateral Nasal
Ascending Palatine
Maxillary Artery
Posterior Ethmoidal
Greater Palatine
Sphenopalatine
Lateral Nasal
Posterior Septal
KIESSELBACH’S PLEXUS (Little’s
area)
• In anterior inferior part
of nasal septum
• Most common site for
Epistaxis
• Mainly anterior epistaxis
1. septal br. Of
sphenopalatine
2. Anterior ethmoidal
3. Septal br. Of superior
labial
4. greater palatine arteries
WOODRUFF’S PLEXUS
• Posterior end of inferior Turbinate
• Venous plexus
• Most common site for posterior
epistaxis
CLASSIFICATION
• Primary – no proven causal factor
• Secondary- proven causal factor
present
CLASSIFICATION
Adult Vs Childhood Epistaxis
1. Childhood Epistaxis <16yrs
2. Adult Epistaxis >16yrs
• There is a pronounced bimodal
distribution in onset of Epistaxis
• More common in childhood, becomes
less common in early adulthood and
peaks again in 6th decade
CLASSIFICATION
Anterior Posterior
Incidence More common Less common
Site Little’s Area Posterosuperior part
or anterior of nasal cavity
part of lateral
wall
Age Children and >40yrs
young Adults
Cause Traumatic Spontaneous
LOCAL CAUSES
1. Congenital : unilateral choanal atresia, meningocoele,
encephalocoele, hemangioma etc..
2. Acquired :
INFECTIONS-
Acute – Viral, Bacterial, Fungal
Chronic Specific – tuberculosis, Syphylis, Leprosy,
Rhinoscleroma
Chronic Non specific – Ozoaena