EPISTAXISGlenPorter,MDFrancisB.Quinn,MDUTMB-GalvestonGalveston,TexasIntroductionandHistory5-10%ofthepopulationexperienceanepisodeofepistaxiseachyear.10%ofthosewillseeaphysician.1%ofthoseseekingmedicalcarewillneedaspecialist.Mythology:brownpaper,nails,scissors,scarletthreads,“leadthathasnevertouchedtheground”Aconditionwithalonghistory—HippocratestoHenryGoodyear.Anatomy/PhysiologyofEpistaxisAnatomyNasalcavityVascularsupplyPhysiologyVascularnatureMucosaWhybleedingfromthenose?Vascularorgansecondarytoincredibleheating/humidificationrequirementsVasculaturerunsjustundermucosa(notsquamous)ArterialtovenousanastamosesICAandECAbloodflowAnatomyoftheLateralNasalWallSPF-classI(35%)-classII(56%)-classIII(9%)ExternalCarotidArtery-Sphenopalatineartery-Greaterpalatineartery-Ascendingpharyngealartery-Posteriornasalartery-SuperiorLabialarteryInternalCarotidArtery-AnteriorEthmoidartery-PosteriorEthmoidarteryPterygopalatineVasculature--InternalmaxillaryarteryAnatomyoftheNasalCavityandVasculatureSphenopalatineAAEthmoidAAGreaterPalatineAKesselbach’sPlexus/Little’sArea:-AnteriorEthmoid(Opth)-SuperiorLabialA(Facial)-SphenopalatineA(IMAX)-GreaterPalatine(IMAX)Woodruff’sPlexus:-Pharyngeal&Post.NasalAAofSphenopalatineA(IMAX)Anteriorvs.PosteriorMaxillarysinusostiumAnterior:younger,usuallyseptalvs.anteriorethmoid,mostcommon(>90%),typicallylessseverePosterior:olderpopulation,usuallyfromWoodruff’splexus,moreserious.EtiologyLocalfactorsVascularInfectious/InflammatoryTrauma(mostcommon)IatrogenicNeoplasmDessicationForeignBodies/otherEtiologySystemicfactorsVascularInfection/InflammationCoagulopathyLocalFactors--VascularICAAneurysmsextraduralcavernoussinusLocalFactors-Infection/InflammationRhinitis/SinusitisAllergicBacterialFungalViralLocalFactors-TraumaNosepickingNoseblowing/sneezingNasalfractureNasogastric/nasotrachealintubationTraumatosinuses,orbits,middleear,baseofskullBarotraumaNasalFracturewithSeptalHematomaLocalFactors-IatrogenicnasalinjuryFunctionalendoscopicsinussurgeryRhinoplastyNasalreconstructionLocalFactors-NeoplasmJuvenilenasopharyngealangiofibromaInvertedpapillomaSCCAAdenocarcinomaMelanomaEsthesioneuroblastomaLymphomaLocalFactors–DessicationCold,dryair—morecommoninwintertimeDryheat—PhoenixandDeathvalleyNasaloxygenAnatomicabnormalitiesAtrophicrhinitisLocalFactors-OtherSelf-inflicted(pedi)vs.traumaticforeignbodiesIntranasalparasitesSeptalperforationChemical(cocaine,nasalsprays,ammonia,etc.)SystemicFactors--VascularHypertension/ArteriosclerosisHereditaryHemorrhagicTelangectasias(OWR)SystemicFactors–Infection/InflammationTuberculosisSyphillisWegener’sGranulomatosisPeriarteritisnodosaSLESystemicFactors–CoagulopathiesThrombocytopeniaPlateletdysfunctionSystemicdisease(Uremia)drug-induced(Coumadin/NSAIDs/Herbalsupplements)ClottingFactorDeficienciesHemophiliaVonWillebrand’sdiseaseHepaticfailureHematologicmalignanciesEtiologyandAgeChildren—foreignbody,nosepicking,nasaldiptheria(1/3withchronicbleedshavecoagulationd/o)Adults—trauma,idiopathicMiddleage—tumorsOldage--hypertensionInitialManagementABC’sMedicalhistory/MedicationsVitalsigns—needIV?PhysicalexamAnteriorrhinoscopyEndoscopicrhinoscopyLaboratoryexamRadiologicstudiessuctiongoodlightanestheticsilvernitratemerocelsgelfoambacitracinendoscopessuctionbovie/bipolarAfrinT.C.A.surgicelepistatbayonetforceptsvaselinegauzeNon-surgicaltreatme...
