Beruflich Dokumente
Kultur Dokumente
MM Carr DDS MD
Reviewed by E.Massoud MD MSc FRCSC,
Assistant Professor, Dept. of Otolaryngology,
Dalhousie University
ANATOMY
Blood Supply
1.Internal Carotid Artery
Anterior and Posterior Ethmoidal Aa
2.External Carotid Artery
Internal Maxillary A. gives off
Sphenopalatine A.
There are other vessels involved but these are
the most important ones!!
Remember that sensory nerves follow the
general pattern of these vessels. CN V1 and
V2 supply the interior nose (Ant. Ethmoidal N.
and Nasopalatine N. respectively).
Little's Area
An area at the anterior inferior nasal septum
where the major vessels anastomose
(Kiesselbach's Plexus) (see diagram). It is an
area of anastomosis for the Sphenopalatine,
Anterior Ethmoid, and Superior Labial Arteries.
This is the MOST COMMON site of epistaxis.
ETIOLOGY
1.Local
1.Trauma (*MOST COMMON)
Fractures-facial and nasal
Self-induced-digital trauma,
foreign body
Iatrogenic-nasal/sinus/orbital
surgery
2.Barometric changes
3.Nasal dryness-combination of dry air
(Canadian winters), septal deformities
4.Septal perforation
5.Chemical
Cocaine
Nasal sprays (both steroids and
decongestants)
Ammonia
Others-gasoline, phosphorus,
chromium salts, sulfuric acid, etc.
6.Tumours
Benign: polyps, inverting
papilloma, angiofibroma
Malignant: squamous cell
carcinoma,
esthesioneuroblastoma
7.Inflammation
Rhinitis-allergic, non-allergic
Infections-bacterial, viral, fungal
2.
3.Systemic
1.Coagulopathies
Anticoagulant use-Coumadin,
heparin
NSAIDS
Hemophilia
Von Willebrands disease
Hematological malignancies
Liver failure
Uremia
2.Granulomatous disorders
Wegener's disease
Systemic lupus erythematosis
Periarteritis nodosa etc.
3.Vascular
Hypertension
Atherosclerosis
Osler-Weber-Rendu disease
(hereditary hemorrhagic
telangiectasia)
MANAGEMENT
See the Epistaxis Module for complete primary
care management of epistaxis.
I. General Assessment
1.Airway patency
2.Vital signs-BP, pulse, respiration
3.Maintain pressure on nose (patient
pinches anterior nose and leans forward)
4.Assess blood loss and side of bleeding
(ask patient to quantify blood loss)
5.Important and relevant medical problems:
cardiac, BP, cancer, previous epistaxis,
allergies to medications (ie: local
anesthetics)
6.IV access if indicated
7.Establish rapport with patient. Obtain
consent and cooperation by explaining
what you're going to do
II. Examination
1.Good light
2.Appropriate suction
3.Anesthesia +/- vasoconstrictors
o Use topical 4% lidocaine on cotton
c. Gelfoam or Surgicel
o Local hemostatic agents which resorb;
can eat/talk
Inflate balloons with saline