Epistaksis

Epistaxis

Nanang Mardiraharjo, dr., Sp.THT-KLEpistaxis a common condition Presenting in 7% to 14% of the general population each year. Most patients: bleed is minor and usually stops quickly do not seek medical attention.Incidence : higher in males than females, more frequent in the winter months than the summer months.

Vascular Anatomy of the NoseBlood supply of the nose:The major portion : the external carotid system Smaller component : the internal carotid system.

ETIOLOGY OF EPISTAXIS

Epistaxis Can Vary TREATMENT EPISTAXISObservation (especially in pediatric patients)Antiseptic creamBarrier ointment (petroleum jelly)CauterizationNasal packing: anterior pack, posterior nasal pack, nasopharyngeal balloonPterygopalatine fossa blockLaser photocoagulationPharmacologicSurgical arterial ligationAngiographic embolizationSurgical reconstruction

Minor HemorrhageMost episodes of epistaxis are minor and stop spontaneouslyOptimal management of recurrent nosebleeds in the pediatric population remains unknown

Antiseptic creams reducing vestibulitis and mucosal inflammation moistening the mucosa and preventing drying and crusting. Barrier ointments preventing crusting of the septal mucosa reduce mucosal friability decrease the frequency of minor epistaxisSilver nitrate cautery little's areaNasal pack Exsanguinating HemorrhageUsually occurs after major traumaAnterior skull base fractures anterior and posterior ethmoidal arteriesFractures of the maxilla internal maxillary artery or one of its branchesSphenoid is involved traversing the internal carotid artery catastrophic bleedingManagementA-B-C-Dpostnasal space balloon catheter + 15 mL salinepacked with ribbon gauze (soaked in bismuth iodoform paraffin paste petroleum gauze coated with antibiotic ointment, boorzalf) sphenopalatine artery ligation external carotid ligationligation of the anterior and the posterior ethmoidal arteryMassive hemorrhage from the sphenoid region internal carotid injury

Sagittal section through the nose demonstrating the techniques for layering ribbon gauze in the nose for tamponade of the bleeding blood vessel

EMERGENCIES EXSANGUINATING EPISTAXIS

COMPLICATIONS EPISTAXIS MANAGEMENT