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Epistaxis Dr. Abdussalam M jahan ENT depart, Misurata university, faculty of medicine.

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Presentation on theme: "Epistaxis Dr. Abdussalam M jahan ENT depart, Misurata university, faculty of medicine."— Presentation transcript:

1 Epistaxis Dr. Abdussalam M jahan ENT depart, Misurata university, faculty of medicine

2 Arterial supply of the septum
Woodruff’s plexus = naso-nasopharyngeal plexus Kisselbach’s plexus in Little’s area

3 Kiesselbach’s Plexus/Little’s Area:
-Anterior Ethmoid (ICA) -Superior Labial A (Facial) -Sphenopalatine A (IMAX) -Greater Palatine (IMAX) Woodruff’s Plexus: - Sphenopalatine A (Pharyngeal & Post. Nasal branches) (IMAX) -Posterior ethmoid (ICA)

4 Classification: Anterior epistaxis (90%) Posterior epistaxis (10%)
Bleeding from Little’s area. Controlled by an anterior pack Younger patients Posterior epistaxis (10%) Occurs in the area of Woodruff’s plexus Older patients Epistaxis not controlled by anterior nasal packing.

5 Local Factors - Inflammation
Etiology: Local Factors - Inflammation URI allergic rhinitis Sinusitis Increased vascularity and greater friability of vessels in inflamed mucosa

6 -Trauma Nose picking Nose blowing/sneezing Nasal fracture
Nasogastric/nasotracheal intubation Trauma to sinuses, orbits, middle ear, base of skull Barotrauma

7 -Iatrogenic nasal injury
Functional endoscopic sinus surgery Septoplasty or Rhinoplasty Nasal reconstruction

8 -Neoplasm Juvenile angiofibroma Inverted papilloma SCCA Adenocarcinoma
Melanoma Lymphoma

9 -Others: Cold, dry air—more common in wintertime Dry heat.
Anatomic abnormalities (ie: nasal septal deformity - turbulent flow (dry mucosa leading to crusting) Atrophic rhinitis

10 foreign bodies Intranasal parasites Septal perforation Chemical (cocaine, nasal sprays, ammonia)

11 Systemic factors Vascular. Infection/Inflammation. Coagulopathy.

12 :- Vascular Hypertension
Hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu disease) subepidermal vessels lacking elastic tissue in capillary wall and deficiency of smooth muscle

13 – Infection/Inflammation
Tuberculosis Syphillis Wegener’s Granulomatosis Periarteritis nodosa SLE

14 – Coagulopathies Primary coagulopathies (hemophilia, von Willebrand’s disease, thrombocytopenia and polycythemia vera). Secondary coagulopathies (uremia, alcoholism, chronic liver disease, leukemia, myeloma, aplastic anemia, idiopathic thrombocytopenis purpura or hypovitaminosis). Iatrogenic coagulopathies (heparin)

15 Etiology and Age Children - foreign body, nose picking
Adults - trauma, idiopathic Middle age - tumors Old age - hypertension

16 Management: Initial Management: ABC’s. Vital signs—need IV.
Medical history/Medications. Labs. Physical exam – Rhinoscopy

17 Exam and treatment options

18 Non-surgical treatments
Topical decongestants/vc. Cautery (AgNo3) Nasal packing. Control of hypertension Correction of: coagulopathies/thrombocytopenia

19 Nasal packing: Anterior nasal packs Posterior nasal packs Traditional
Recent modifications Posterior nasal packs

20 Packing

21 Posterior Packs – Admission
Elderly and those with other chronic diseases may need to be admitted to the ICU Continuous cardiopulmonary monitoring Antibiotics Oxygen supplementation may be needed Mild sedation/analgesia IVF

22

23 Discharge instructions
Humidity/emolients Nasal saline sprays Avoidance of nose picking/blowing Sneeze with mouth open Avoid straining Avoid hot/spicy food

24 Indications for surgery:
Continued bleeding despite nasal packing Nasal anomaly interfering with packing Patient refuse/intolerance of packing Posterior bleeding with failed non surgical treatment after >72hrs

25 :Surgical treatment Transmaxillary IMA ligation
Transnasal Sphenopalatine ligation External carotid artery ligation Anterior/Posterior Ethmoidal A. ligation Last one

26 The end


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