EPISTAXIS

INTRODUCTION :

Pinching of nose to stop epistaxis is known as Hippocratic Technique.

Little’s area also known as Locus Valsalvae.
Woodruff’s plexus is posteroinferior to inferior turbinate
80% of nasal septum supplied by ECA whereas 20% by ICA
Venous epistaxis from Retrocolumellar vein tends to occur in subjects under the age of 35 yrs
Rhinologist artery = Sphenopalatine artery

DEFINITION :

Epi – Above Stazo – to drip (Greek origin)

Epistaxis is defined as bleeding from inside the nose.

VASCULAR SUPPLY :

The general rule of the thumb is that the area of nasal cavity below the level of middle turbinate has
rich blood supply from the External carotid system, where as the area above the middle turbinate
receives extensive supply from the Internal carotid artery.

EXTERNAL CAROTID ARTERY

Facial Artery Superior labial artery (anteroinferior septum), Lateral Nasal Artery (Vestibule)
Maxillary Artery Sphenopalatine (from 3rd part), Greater Palatine artery
Sphenopalatine gives inferior and middle turbinate arteries

INTERNAL CAROTID ARTERY

Ophthalmic Artery Anterior and Posterior Ethmoidal arteries

Anterior ethmoidal artery gives superior turbinate branch.
Posterior ethmoidal artery gives supply to sphenoethmoidal recess

VENOUS DRAINAGE :

Follows arteries except venous cuff surrounding the intra osseous portions of the inferior and middle
turbinate arteries.
Lateral Wall veins SPF Pterygoids plexus of veins Internal Jugular Vein
Superior Labial, Greater palatine Facial vein External Jugular Vein
Retrocolumellar vein joins the venous plexus of lateral nasal wall.
AREA called Little’s area and PLEXUS called Kiesselback’s plexus – Major Site of bleed.
LITTLE'S AREA: This area is located in the anterior part of the cartilagenous portion of the nasal
septum.
Septal branches of Sphenopalatine artery
Greater palatine artery
 Septal branch of Superior labial artery
Anterior ethmoidal artery

Woodruff’s plexus : Collection of blood vessels in inferior meatus posteriorly. Appear to originate
from posterior pharyngeal wall.
Branches from :
Ascending pharyngeal artery (smallest b/o external carotid)
Posterior nasal b/o Sphenopalatine
Sphenopalatine

CLASSIFICATION

1. Primary or Secondary
2. Spontaneous or Induced
3. Anterior or Posterior
4. Adult or childhood
Anterior epistaxis is defined as bleeding from a source anterior to pyriform aperture.
Maxillary sinus ostium is the dividing line for anterior and posterior epistaxis
Childhood epistaxis <16yrs and adult >16yrs
Children particularly susceptible because of high vascularity and higher incidence of URTI
3-8 yrs peak incidence, more so during winters
Mechanism is drying and crusting of nasal mucosa.

CAUSES

LOCAL SYSTEMIC HORMONAL IDIOPATHIC

HTN
Trauma : self inflicted, Bleeding diathesis
surgery, facial fractures, Leukaemia
Puberty
septal perforations, Acute nephritis
Pregnancy
Barotrauma, foreign Vit K deficiency
bodies Mitral stenosis
Hodgkins Lymphoma

Iatrogenic :
Infections : Vestibulitis,
Aspirin
acute rhinitis, adenoiditis,
Anticoagulant
diphtheritic rhinitis,
Penicillin
atrophic rhinitis, rhinitis
Phenytoin
caseosa
Chloramphenicol
GRANULOMATOUS
Alcohol
like leprosy, SLE,
Immunosuppressant
Syphilis, TB, Wegners,
Fexofenadin/Allegra
eosonophilic granuloma
Ginseng
FUNGAL