10.1,10.2,10.

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

2. Disorder of blood and blood vessels -coagulopathy ,blood dyscarias

3. Liver disease –alcoholic liver disease (2.7.9.10)

4. Drugs –herbal medicines, anticoagulant, antiplatelet, aspirin

5. Mediastinal compression –tumors , ↑venous pressure in nose

6. Acute general infection –influenza,malaria,dengue,measles

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

 Blood flow from front of nose when

patient in sitting position.

POSTERIOR

 Mainly blood flows back into the throat

 Patient may swallowed- coffee coloured
vomitus
10.4,10.5,10.6
SEPTAL HEMATOMA
 Collection of blood under mucoperichordium of nasal septum

 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

 Cause: 2nd infection of septal hematoma

 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.