causes of epistaxis

7/22/2019 Causes of Epistaxis

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EPISTAXIS

BY : NORAINI BT MOHD MUSTAFAR


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Bleeding

from

inside the

nose

What is epistaxis


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Blood supply of nose

Blood supply

of nose

Nasal septum

Internalcarotid

system

Externalcarotid

system

Lateral wall

Internalcarotid

system

Externalcarotid

system


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Blood supply of nasal septum

Internal carotidsystem:

Anterior ethmoidal

artery

Posterior ophthalmicartery

External carotid

system:

Sphenopalatine arterySeptal branch of

greater palatine artery

Superior branch of

superior labial artery


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Blood supply of lateral wall

Internal carotid system:Anterior ethmoidal

Posterior ethmoidal

External carotid systemPosterior lateral nasal

branches

Greater palatine artery

Nasal branch of

anterior superior dental

Branches of facial

artery to nasalvestibule


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Ant.ethmoidal

Septal branch of sup.labial

Septal branch ofsphenopalatine

Greater palatine

Little area

Situated under the posteriorend of inferior turbinate wheresphenopalatine arteryanastomoses withpost.pharyngeal a.

Woodruffsarea

Area of epistaxis


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Areas of epistaxis


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Causes of epistaxis

Cause ofepistaxis

local general idiopathic


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Localcause

trauma

infection

Foreignbodies

Neoplasm

Atmosphericchanges

Deviatednasal

Adenoiditis

Malignant

tumor


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Generalcause

CVS

Blooddisorder

Liver disease

Kidneydisease

Drug

Mediastinalcompression

Acutegeneralinfection


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Sites of epistaxis

Little area

90% bleedfrom this site

Above thelevel middleturbinate

Bleed from ant.& postethmoidalvessel

Below thelevel ofmiddle

turbinate Bleed from

branches ofsphenopalatinea.

Posteriorpart of nasalcavity

Blood flowdirectly to thepharynx

Diffuse

Bleed fromseptum andlateral nasalwall


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SITES OF EPISTAXIS


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Classification of epistaxis

Anterior Posterior

Incidence More common Less common

Site Little area or anterior

part of lateral wall

Posterosuperior part of

nasal cavity ( diffcult to

localise the bleeding

point

Age Childs/young adult > 40 years old

Cause Trauma Spontaneous ( hpt,

ateriosclerosis )

Bleeding Mild can be controlled bylocal pressure or anterior

pack

Bleeding is severe, needhospitalization, post

nasal pack often

required


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management

Mode of onset

Duration and frequency

Amount of blood loss Side of nose where bleeding is occuring

Bleeding tendency in family

History of known medical illness History of drug intake


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MANAGEMENT

First aid

Pinch the

nose withthumb and

index finger

for 5minutes


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MANAGEMENT

Trotters

method

Sitting position

Lean a littleforward over a

basin to spit

any blood

Breathethrough the

mouth


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MANAGEMENT

Cold compress

reflex

vasoconstriction


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MANAGEMENT

Cauterisation

Anterior epistaxis; bleeding pointlocated

Anaesthetised

Bleeding point cauterised withbead silver nitrate /electrocautery


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MANAGEMENT

Profuse bleeding and/or bleeding sitedifficult to localise

Ribbon gauze soaked with liquidparaffin; 1m gauze(2.5cm wide inadults, 12mm in children) each nasalcavity

First few cm folded upon itself andinserted along the floor

Layer the gauze from floor to roof

Anterior nasal packing


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MANAGEMENT

Anterior nasal packing

One or both cavities

Can be removed after 24 hours of bleeding

has stoppedSystemic antibiotics to prevent sinus

infection and toxic shock syndrome


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MANAGEMENT


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MANAGEMENT

Anterior nasal pack


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MANAGEMENT

Anterior nasal pack


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MANAGEMENT

When is it required?

Bleeding posteriorly intothe throat

Posterior nasal packing


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MANAGEMENT

Posterior nasal packinga catheter is passedthrough the affectednostril and throughthe nasopharynx,

and drawn out of themouth

gauze pack is secured tothe end of the catheterusing umbilical tape or

suture material, with longtails left to protrude from

the mouth

gauze pack is guidedthrough the mouth andaround the soft palateusing a combination ofcareful traction on the

catheter and pushing with

a gloved finger

It is secured inposition bymaintaining tension

on the catheter with apadded clamp or firm

gauze roll placed

anterior to the nostril.


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MANAGEMENT

Posterior nasal packing


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MANAGEMENTEpistaxis balloon

Foleys catheter 12-14Finserted

Balloon is inflated with5-10mL saline

Bulb inflated with saline

is pulled forward so thatchoana is blocked

Anterior nasal pack kept

in the usual manner


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MANAGEMENT

Epistaxis balloon


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MANAGEMENT

Endoscopic Cautery

Posterior bleeding

Endoscope

Coagualated with suction cautery

Local anesthesia

MANAGEMENT


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MANAGEMENTElevation of Mucoperichondrial Flap

and SMR Operation

Persistent orrecurrent bleedfrom septum

Elevation ofmucoperichondr-ial flap and

repositioning

Cause fibrosisand constrictblood vessel

Elevation ofmucoperich-ondrial flap Remove any

septal spur

SMR


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Ligation of vessel

External carotid

Bleeding fromexternal

carotid + failedconservativetherapy

Complication ::embolisation

or ligation ofmoreperipheralbranch

Maxillary artery

Indicate foruncontrollable

posteriorepistaxis

caldwell-lucoperation

Ethmoidalarteries

Anterosuperiorbleeding

above middleturbinate

Not controlledby packing

causes of epistaxis

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