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Epistaxis
Epistaxis
3
ANATOMY,
CAUSES,
CLASSIFICATION
BLOOD SUPPLY
NASAL SEPTUM
LATERAL WALL
LITTLE’S AREA
WOODRUFF PLEXUS
INTERNAL CAROTID SYTEM
EXTERNAL
CAROTID SYTEM
1. Sphenopalatine artery
2. Greater palatine artery (septal)
3. Superior labial artery (septal)
SUMMARY OF BLOOD SUPPLY
KIESSELBACH’S
PLEXUS
Located at the Little’s
area
1 cm above nasal
floor
1 cm behind ant end
of vestibule
CAUSES OF EPISTAXIS
1.Local- nose/nasopharynx
2.General
3.Idiopathic –childhood/adult
LOCAL
NOSE NASOPHARYNX
1. Trauma (nasal fracture,violent sneeze,fingernail,post surgery) 1. Adenoiditis
2. Infectious (nosepicking,acute,chronic) 2. Juvenile angiofibroma
3. Foreign body 3. Malignant tumors
4. Neoplasms of nose +
paranasal sinuses
5. Atmospheric changes (Caisson dx)
6. Deviated nasal septum
7. Septal perforations
GENERAL
1. Cardiovascular system –HPT, arteriosclerosis
7. Vicarious menstruation
OTHERS –HEREDITARY
HAEMORRHAGIC
TELANGIECTASIA
Rare autosomal dominant
Any time of life ,most
common in early adult life
+ recurrent epistaxis
CLASSIFICATION OF
EPISTAXIS
ANTERIOR
POSTERIOR
Causes:
Nasal trauma
Surgery
Bleeding disorders
Clinical presentation:
Bilateral nasal obstruction: difficulty in breathing
Frontal headache
Sense of pressure in nasal bridge
Examination:
Smooth and rounded swelling
Soft and fluctuant
Treatment:
Small: aspirate by sterile needle
Large: incise and drain
Systemic antibiotic
Complication:
Septal abscess
Fibrosis and necrosis
SEPTAL ABSCESS
Collection of pus between mucoperichondrium and septal cartilage
Clinical presentation:
Severe bilateral nasal obstruction
Pain and tender over nasal bridge
Fever and chills
Frontal headache
Redness/swelling of skin
Examination:
Smooth bilateral swelling
Fluctuation
Septal mucosa is congested
Submandibular LN enlarged and tender
Treatment:
Incise and drain
Suction
Systemic antibiotic
Complications:
Necrosis
Septal perforation
Meningitis
Cavernous sinus thrombosis
10.7,10.8
NASAL TRAUMA
Any injury to the nose or related structure that may result in bleeding, a physical deformity, a decreased
ability to breathe normally because of obstruction, or an impaired sense of smell.
Causes:
1) Fingernail trauma (nose pricking,
obsessive compulsive disorder)
2) Injuries (mva, sports, personal
accidents, fight, post-surgery)
3) Maxillofacial trauma
4) Nasal intubation
5) Foreign bodies
6) Forceful nose blowing
7) Violent sneeze
Clinical features :
1. Swelling of nose. Appears within few hours and may obscure details in examination
2. Periorbital ecchymosis
3. Tenderness
4. Nasal deformity. Nose may be depressed from the front side, or the whole of the nasal pyramid
deviated to one side.
5. Crepitus and mobility of fractured fragments
6. Epistaxis
7. Nasal obstruction due to septal injury or hematoma
8. Lacerations of nasal skin with exposure of nasal bones and cartilage may be seen in compound
fractured.
FOREIGN BODY NOSE
Commonly in children aged 2-3 years.
Can be classified :
1) Inorganic (metal objects, buttons,
plastic objects)
2) Organic (wood, paper, cotton-wool,
rubber, polystyrene beads) • May lie undetected for many weeks,
no symptoms, and accidentally found
during examination.
• Local inflammatory reaction will take
place, and nasal discharge is produce
at affected region.
• Becomes purulent and foul-smelling,
sometimes bloodstained.
• Secondary inflammatory response of nasal vestibular
skin (vestibulitis) may develop as a result of constant
nasal discharge.
• For these reasons, any foul-smelling of unilateral
nasal discharge in a child, with or w/o excoriation of
vestibular skin, should be assumed due to foreign
body until proven otherwise.
Late presentation of nasal foreign body
Such retained foreign bodies may eventually present with unilateral nasal congestion, epistaxis,
discharge.