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Epistaxis: Causes, Classification, and Management

Epistaxis, or nosebleeds, can be a common and potentially serious condition. This article explores the causes, classification, and management of epistaxis, including various treatment options.

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Epistaxis: Causes, Classification, and Management

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  1. Dr.Varun.S Dept.of .Surgery Skhmc

  2. INTRODUCTION • Bleedingfromnostril,nasalcavityornasopharynx • Mostoftenselflimited,butcanoftenbeseriousand lifethreatening • 5-10% of the population experience an episode of epistaxiseachyear,10%ofthosewillseekaphysician and1%of thosewillneedaspecialist • Canoccurinallagegroups

  3. REASON FOR EXCESSIVEBLEEDING • Richvascularity • Suppliedbybothinternalandexternalcarotidsystem • Variousanastomosesbetweenarteriesandveins • Bloodvesselsrununderthemucosaunprotected • Largervesselsontheturbinateruninbonycanals– cannotcontract

  4. VASCULATURE OFNOSE  Branches ofinternal carotid system: . AnteriorEthmoidal artery . Posteriorethmoidal artery  Branches ofexternal carotid system: . Sphenopalatine artery- majorbranch . Greaterpalatine artery . Superior labial branch of facialartery . Infraorbitalbranch of maxillaryartery

  5. KIESSELBACH’S PLEXUS (Little’sarea) • Inanteriorinferiorpartof nasalseptum • Most commonsite for • epistaxis • Mainly anteriorepistaxis • septal br. Of sphenopalatine • Anteriorethmoidal • Septal br. Ofsuperior labial • greater palatinearteries anastomosehere

  6. WOODRUFF’SPLEXUS • Posterior endof middle turbinate • Sphenopalatine artery anastomoses with posterior pharyngeal artery • Mostcommonsitefor posteriorepistaxis

  7. CLASSIFICATION Anterior Epistaxis  Posterior Epistaxis . Morecommon . Occurs inchildren and youngadults . Usually dueto nasal mucosal dryness .Alarming as bleeding seen readily but generally less severe . Usuallyolder population . HTN andASVD are the most common causes . Significant bleedingin posteriorpharynx . More severe and treatment more challenging

  8. LOCAL CAUSES OFEPISTAXIS . A. Congenital – Hereditarytelengiectasia B. Trauma . Nosepicking . Facial and skull bonefractures . Foreignbody . Iatrogenictrauma . Hard blowing, violentsneeze

  9. Inflammatory . Infectiverhinitis Specific . Acute –Diphteria . Chronic granulomatous- TB, Leprosy,Syphilis, Rhinosporiodiasis

  10. NonSpecific . Viral – Common cold,Influenza . Bacterial – Secondary bacterial rhinitissinusitis . Fungalrhinosinusitis . Atrophicrhinitis Physiological . Highaltitude .Extremecoldorhotclimate

  11. Neoplastic .Benign–Juvenileangiofibroma,angiomaof septum,capillaryandcavernoushemangioma . Malignant – SCC, Olfactoryneuroblastoma, Nasopharyngealcarcinoma Miscellaneous . Deviated septum &spur . Rhinitissicca . Spontaneous ruptureof vessels .Rhinolith

  12. SYSTEMICCAUSES • Hypertension-commonest • Cardiac –CCF, Mitralstenosis • Pulmonary–COPD • Cirrhosis – VitaminK • deficiency • Renal–Nephritis • Drugs – Excessive use of salicylates ,anticoagulants • Coagulopathies – Clotting disorders bleedingdisorders Agranulocytosis Leukemia • Vitamin K deficiency Exanthematousfevers • Hormonal – Vicarious Menstruation,endometriosis, granulomagravidarum • IdiopathicCauses

  13. PATIENTHISTORY • Previous bleedingepisodes • Onset,duration,frequency,amountofbloodloss • h/otrauma • Family history ofbleeding • Hypertension • Hepaticdiseases • Drughistory • Any other medicalailment

  14. MANAGEMENT • Locate the bleeding site • Anteriorand Posteriorrhinoscopy • Diagnostic Nasal Endoscopy • INVESTIGATIONS: • .Hematologicalinvestigations – Hb%, TLC, DLC, BT,CT, • Platelet count, prothrombintime • . Blood urea, liver functiontests • .Radiology–x-rayandCTscanofnose,PNSand nasopharynx • .Otherinvestigationsdependinguponthepossiblecause

  15. TREATMENT OFEPISTAXIS  Firstaid .ABC . Trotter’s method- Make patient sit up, pinchthenosefor5-10 minutes. Head bent forward. Open mouth andbreathe . Icepacks

  16. DEFINITIVETREATMENT • CAUTERIZATION • .ChemicalcauterywithSilvernitratesticks,TCA (3%), Chromic acidbead • .Electrocautery • Vasoconstrictor sprays /anesthetics • Anteriornasalpackingoranteriorepistaxisballoons for refractoryepistaxis

  17. ANTERIOR NASALPACKING

  18. METHODS OF INSERTING ANTERIOR NASALPACK

  19. NASAL SPONGEPACK/TAMPON

  20. POSTERIOR NASALPACKING • Ifbleedingdoesnotstopafteranteriorpacking • Posteriorepistaxis

  21. FOLEY’S CATHETER and EPISTAXIS BALLOON

  22. COMPLICATIONS OF NASAL PACKING • SEPTAL HAEMATOMA /ABSCESS • SINUSITIS • PRESSURENECROSIS • TOXIC SHOCKSYNDROME NECROSIS OFALA

  23. PATIENTS ON NASALPACK • Besttoplacepatientonantibioticstodecreaseriskof sinusitisandtoxicshocksyndrome • Advisepatienttoavoidstraining,bendingforwardor removing packearly • If other nostril is unpacked advise patient topical salinesprayorsalinegeltomoisturizenasalmucosa • Admittedandmonitoredinseverecases

  24. OTHER TREATMENTS FOR REFRACTORYEPISTAXIS • Greater palatine foramenblock • Septoplasty • Endoscopiccauterization • Internal maxillary arteryligation • Transantral sphenopalatineartery ligation • Intraoral ligation of maxillaryartery • Anteriorandposteriorethmoidarteryligation • Selectiveembolisation • External carotid arteryligation

  25. THANKYOU

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