Epistaxis + facial pain Flashcards
Describe the external nose
upper 2/3 is bony
lower 2/3 is cartilaginous
Describe the nasal septum
nasal cavity divided by a midline osteocartilaginous septum
marked deviation can cause blockage or external cosmetic deformity
Name the 4 paired sinuses
frontal
maxillary
ethmoid
sphenoid
What are the sinuses?
extensions of nasal cavity as air-filled spaces into skull bones
Describe the vascular supply of the nose
both the internal and external carotid arteries supply the nose
the carotid system anastamoses at ‘Little’s area’ or ‘Kiesselbach’s plexus’
Describe the nerve supply of the nose
sensory supply is via maxillary division of the trigeminal nerve
nasal vascular supply is constricted by sympathetic nerve stimulation and dilated by parasympathetic
Functions of the nose
filtration + protection
olfaction
humidification + warming
vocal resonance
Local causes of epistaxis
idiopathic
infection
trauma
neoplasia
foreign body
General causes of epistaxis
hypertension
drugs (anticoagulants)
blood diseases (leukaemia)
hereditary haemorrhagic telangiectasia
Treatment of epistaxis if nose not actively bleeding
naseptin, bactroban or vaseline
cauterise if bleeding point can be identified - silver nitrate cautery after local anaesthetic
Treatment of epistaxis if nose actively bleeding
initial first aid measures - pressure at top of nose, lean forward, ice pack + suck an ice cube
assessment of blood loss
evaluation of the cause
procedures to stop continued bleeding
How do you assess blood loss from epistaxis?
record pulse + BP
(vital to appreciate adequate BP may be maintained by rising pulse rate - decompensation may be sudden)
other signs of shock - pallor + sweating
IV fluids
FBC, clotting screen, Group + save
How can bleeding be controlled in epistaxis?
nasal cautery - silver nitrate, electrocautery
nasal packing - merocel pack, BIPP ribbon gauze
surgery - ligation of vessels
What causes septal haematoma and how is it treated?
may occur with nasal trauma
need to drain haematoma otherwise septal perforation or nasal deformity will occur
How are nasal fractures treated?
soft tissue swelling may hide bony deformity
reduction of deformity at about 10 days
may still be residual deformity or nasal obstruction
Common nose concerns (cosmetically)
deviations of nose to one side
nasal hump
nasal depression
too wide/too narrow nose
tip deformities
How are mandibular fractures treated?
reduce and immobilise the fracture for several weeks by wiring teeth together
What does a malar fracture feel like and how is it treated?
palpation of orbital rim will reveal a step
may damage infraorbital nerve
if fragment depressed, elevation + wiring required
How are maxillary fractures classified?
Le Fort 1,2,3
What causes maxillary fractures and how are they treated?
due to severe force, eg. RTA
movement of hard palate while forehead is held stationary
requires reduction + splinting
What causes auricular haematoma?
occurs following blunt (shearing) trauma typically in sports such as rugby and boxing
can occur with ear studs through cartilage of pinna
haematoma develops between cartilage and perichondrium
How is auricular haematoma treated?
need to remove haematoma
simple aspiration or incision and drainage
pressure dressing or suturing
not treated properly = degeneration of cartilage + scarring = cauliflower ear
General causes of facial pain?
rhinological
dental
vascular
neuralgia
non-organic
What dental causes can cause facial pain?
temporomandibular joint dysfunction
myofascial pain
dental disease
