Epistaxis Flashcards
This is the most common otolaryngologic emergency
Epistaxis
Most of the blood supply of the nose and sinuses would come by the way of the (internal/external) carotid artery through your (internal/external) ________ and _________ artery
External Carotid Artery
Internal Maxillary and Facial Artery
Blood supply via ECA (Some Anatomists Like Freaking Out Poor Medical Students)
Superior Thyroid Artery
Ascending Pharyngeal Artery
Lingual Artery
Facial Artery
Occipital Artery
Posterior Auricular Artery
Maxillary Artery
Superficial Temporal Artery
Internal Maxillary artery gives off to __________ and ________________
Which of the two arteries supply the:
- lower mid septum
- posterior middle turbinate
- posterior septum
Internal Maxillary artery gives off to sphenopalatine artery and descending palatine artery
- lower mid septum: descending palatine artery
- posterior middle turbinate AND posterior septum: sphenopalatine artery
This is the only extracranial branch of the ICA
This branch gives off to ____ and _______
Which of the two arteries supply the:
- Nasal tip
- Nasal Septum
-Lateral wall of the nose
-Superior Turbinate
-Superior Septum
-Posterior lateral wall of the nose
OPHTHALMIC ARTERY
his branch gives off to ANTERIOR ETHMOID ARTERY and POSTERIOR ETHMOID ARTERY
Which of the two arteries supply the:
- Nasal tip, Nasal Septum and Lateral wall of the nose: ANTERIOR ETHMOID ARTERY
-Superior Turbinate, Superior Septum, and Posterior lateral wall of the nose: POSTERIOR ETHMOID ARTERY
T/F: ICA supplies the posterior portion of the nose
F
Superior
Most frequent site of epistaxis
Where does it receive blood from?
Little’s area or Kiesselbach’s plexus
both ICA and ECA
T/F: The posterior epistaxis is more common of the two types of epistaxis
Site of bleeding of the more common form of epistaxis:
Source of bleeding of the more common form of epistaxis : ___________ , originating from the __________________
F- anterior
Site of bleeding: nostrils
Source of bleeding: Little’s Area ,originating from the ethmoid artery system
Most common reason for epistaxis in pediatrics
Digital manipulation
The posterior epistaxis originate from this artery through the back
How does infection/inflammation in the nose cause epistaxis?
Source of bleeding of posterior epistaxis
Most common reason for posterior epistaxis in adults
Internal maxillary artery
There is blood vessels is close to the nasal mucosa; since the mucosa is thin, when there is infection, the resulting inflammation makes the mucosa edematous, which makes it more sensitive and fragile. Nose blowing could then irritate the vessels and cause bleeding
Woodruff’s plexus / Nasal-nasopharyngeal plexus
Hypertensive bleeds
T/F: epistaxis is exclusive to just anterior or posterior type
F - no, especially if the patient’s condition is systemic
Most important thing to do when a patient comes with epistaxis
IDentify site of bleeding through anterior rhinoscopy or nasal endoscopy
Differential diagnosis for epistaxis
New growth (nasopharyngeal carcinoma)
Anatomic deformities (septal spur)
Trauma
Inflammation (rhinitis)
Vascular malformation
Environmental factors
T/F: Most of the time, tumors in the sinonasal area that bleed are considered malignancies
T
Most common locations of new growths
Fossa of Rosenmuller
T/F: Eustachian tube opening, nasopharynx, and rosenmuller fossa are seen via posterior endoscopy
T
they can’t be seen using anterior rhinoscopy
T/F: Nasopharyngeal carcinoma is common in Asia, very common in the PH especially the North
T/F: This disease has a bimodal age distribution
T/F: This has high prevalence in Hong Kong
What is a strong risk factor for this disease?
T
T- 1st peak late childhood, 2nd peak 50-60yo
T- aka Canton Tumor
Dietary factors
T/F: EBV titers are used for prognostication and monitoring of new growths
F - NPCA
This is the most common clinical presentation for NPCA
Neck masses (lymph node metastasis) Level 2 lymph nodes
How does aural fullness occur in NPCA?
Since the neck mass starts from the Rossenmuller fossa, it tends to block the drainage of the eustachian tube > the normal secretions of the middle ear can’t drain properly (decreased ventilation) > secretions pool into the middle ear > aural fullness
How does Diplopia occur in NPCA?
Lateral rectus palsy > affects lateral rectus > diplopia
Gold standard for diagnosis of NPCA
MRI is better for _____ visualization and early bone invasion
CT is better for _______ visualization
Nasopharyngeal biopsy (except in adolescent males due to possible excessive bleeding)
This is only done among adolescent males if vascularity of the tumor cannot be determined through imaging or radiology
MRI- soft tissue
CT- bone
T/F: Surgery is the definitive treatment for NPCA
F: surgery is NOT DONE
instead, chemo and radiotherapy are done
T/F: Chemotherapy acts as a radioensitizer that sensitizes tumor cells to radiation > increases efficacy of radiotherapy
T
How does bleeding occur in septal spur?
The mucosa in the edges of septal spur becomes very thin and sensitive > source of bleeding
T/F: Immediate reduction of nasal fracture is the best treatment
T
T/F: Juvenile Nasopharyngeal Angiofibroma is an example of a vascular malformation that can cause epistaxis
T
T/F: Juvenile nasopharyngeal angiofibroma may cause hyponasal voice and recurrent severe epistaxis
1st choice diagnostic modality:
Tx:?
T
Carotid Angiography (map out feeding vessel > embolize > remove tumor) done in 1 day
-surgical excision
First and most effective management of Epistaxis
Digital PRessure on the NARES, not the nose bridge
What are the does and donts in applying digital pressure?
DO: put pressure on the nares; position neutral or bow slightly
DON’TS: do not put pressure on the nose bridge; do not look up
Putting gauze inside the nose for anterior nasal packing must extend to the __________
posterior choanae
T/F: Electrocautery is suggested for mucosal bleeds
F- NOT suggested as it can cause further lateral damage to mucosa
This management is used for worst case scenarios
Artery Ligation (for internal maxillary artery and sphenopalatine artery)
Used for kids: (absorbable/nonabsorbable) nasal packings
Absorbable- disappears after a couple of weeks
What is the likely cause of epistaxis even after cauterization?
PAtient may have removed the crust that formed after cauterization > lining gets injured > new epistaxis
