ENT

Question 1

Kiesselbach’s plexus

Answer 1

Little’s area

-Common bleeding point in anterior inferior nasal septum

• Anastomosis of 4 arteries
  1) Anterior ethmoidal artery (branch of the ophthalmic artery)
  2) Sphenopalatine artery (terminal branch of the maxillary artery)
  3) Greater palatine artery (from the maxillary artery)
  4) Septal branch of the superior labial artery (from the facial artery)

Question 2

Anterior epistaxis

Answer 2

Little’s area/ Kiesselbach’s plexus

• Anastomosis of 4 arteries
  1) Anterior ethmoidal artery (branch of the ophthalmic artery)
  2) Sphenopalatine artery (terminal branch of the maxillary artery)
  3) Greater palatine artery (from the maxillary artery)
  4) Septal branch of the superior labial artery (from the facial artery)

Question 3

Posterior epistaxis

Answer 3

Posterior bleeding derives primarily from the posterior septal nasal artery (a branch of the sphenopalatine artery), which forms part of the Woodruff plexus.

Question 4

Causes of epistaxis

Answer 4

Local
Idiopathic

Trauma
– Nose picking
– Facial injury
– Foreign body

Inflammation
– Infection
– Allergic rhinosinusitis
– Nasal polyps

Neoplasia
– Benign (for example, juvenile angiofibroma)
– Malignant (for example, squamous cell carcinoma)

Vascular
– Congenital (for example, hereditary haemorrhagic telangiectasia)
– Acquired (for example, Wegener’s granulomatosis)

Iatrogenic
– Surgery (for example, ENT/maxillofacial/ophthalmic)
– Nasal apparatus (for example, nasogastric tube)

Structural
– Septal spurs or deviation
– Septal perforations

Drugs
– Nasal sprays (for example, topical decongestants)
– Abuse (for example, cocaine)

General
Haematological
– Coagulopathies (for example, haemophilia)
– Thrombocytopenia (for example, leukaemia)
– Platelet dysfunction (for example, Von Willebrand’s disease)

Environmental
– Temperature
– Humidity
– Altitude

Drugs
– Anticoagulants (for example, heparin, warfarin)
– Antiplatelet (for example, aspirin, clopidogrel)

Organ failure
– Uraemia
– Liver (for example, cirrhosis)

Other
– Atherosclerosis/hypertension
– Alcohol

Question 5

Chemical cautery for epistaxis

Answer 5

Chemical cautery is achieved by a using silver nitrate stick (75% silver nitrate, 25% potassium nitrate BP w/w) that reacts to the mucosal lining to produce local chemical damage. The technique entails applying the stick to the bleeding point with firm pressure for 5–10 seconds

Question 6

Management of epistaxis

Answer 6

A–> E

Chemical cautery using vasoconstrictive local anaesthetics

Anterior packing

• Nasal tampons
• Formal anterior packing

Posterior packing

• Foley catheter
• Brighton balloon