Lecture 8.2: Epistaxis (Nosebleeds)

Question 1

What is Epistaxis?

Answer 1

Bleeding from the nose

Question 2

Where does the Greater Palatine Artery originate from?

Answer 2

From the 3rd part of the maxillary a.

Question 3

Where does the Greater Palatine Artery enter?

Answer 3

Enters the greater palatine foramen

Question 4

Where does the Greater Palatine Artery give rise to?

Answer 4

Gives lesser palatine branch

Question 5

Where does the Sphenopalatine Artery originate from?

Answer 5

External carotid artery system

Question 6

Where does the Sphenopalatine Artery enter?

Answer 6

Enters the sphenopalatine foramen

Question 7

Where does the Sphenopalatine Artery give rise to? (2)

Answer 7

• Posterior lateral nasal arteries
• Posterior septal branches

Question 8

What is the first branch of the Internal
Carotid Artery? What does it supply?

Answer 8

• Ophthalmic Artery
• Eyes and also the upper part of the nose

Question 9

What are the distributing vessels of the Ophthalmic Artery? (2)

Answer 9

• Anterior ethmoidal artery
• Posterior ethmoidal artery

Question 10

What percentage of nosebleeds have an anterior cause?

Answer 10

90%

Question 11

What percentage of nosebleeds have an posterior cause?

Answer 11

10%

Question 12

Where is the venous drainage of the anterior nose?

Answer 12

• Facial vein

Question 13

Where is the venous drainage of the posterior nose? (2)

Answer 13

• Cavernous venous sinus
• Pterygoid venous plexus

Question 14

Little’s Area (Kiesselbac’s plexus) is supplied by External Carotid artery branches…? (2)

Answer 14

• Greater Palatine Artery
• Superior Labial Artery

Question 15

Where does Little’s Area anastomose with the Internal Carotid Artery?

Answer 15

• Anterior Ethmoidal Artery

Question 16

Where do anterior nosebleeds bleeds originate from?

Answer 16

Little’s Area (Kiesselbach`s plexus)

Question 17

Where do posterior nosebleeds bleeds originate from?

Answer 17

• Woodruffs Plexus
• Predominant flow in the Sphenopalatine branch
  (external carotid and maxillary artery)
• Some superior supply by the posterior ethmoidal
  artery (internal carotid artery)

Question 18

What are the most common causes of Epistaxis?

Answer 18

• Nose Picking
• Trauma
• URTIs
• Dry Air

Question 19

Other Rarer Causes of Epistaxis (5)

Answer 19

• Congenital Diseases
• Inflammatory Causes (nasal granulomatosis, SLE)
• Neoplasia
• Hypertension
• Drugs

Question 20

What Congenital Diseases can cause Epistaxis? (6)

Answer 20

• Platelet Issues (platelet function defect)
• Coagulation Issues (von WiIlebrand’s disease)
• Vascular Issues (Ehlers Danlos)
• Haemophilia
• Haemangiomas
• Hereditary Haemorrhagic Telangiectasia (HHT).

Question 21

What Drugs can cause Epistaxis? (6)

Answer 21

• NSAIDS
• Aspirin
• Intra Nasal Sprays (especially steroids)
• Anticoagulants
• Cocaine
  *Alcohol

Question 22

Epistaxis at home Treatment

Answer 22

• Sit upright and lean your body and your head
  slightly forward
• Breathe through your mouth
• Use a tissue or damp washcloth to catch the blood
• Use your thumb and index finger to pinch together
  the soft part of your nose
• Keep pinching your nose continuously for at least
  five minutes before checking if the bleeding has
  stopped
• If your nose is still bleeding, continue squeezing
  your nose for another 10 minutes
• If you’d like, apply an ice pack to the bridge of your
  nose to further help narrow blood vessels

Question 23

Cautery (Silver Nitrate or Electro) for Epistaxis Treatment

Question 24

Nasal Tampons/Merocel/Rapid Rhino for Epistaxis Treatment

Question 25

Posterior Packing for Epistaxis Treatment

Question 26

Aftercare of Epistaxis (6)

Answer 26

• Naseptin ointment or Mupirocin if Neomycin/ soya/
  peanut allergy
• No nose picking
• Avoid exercise, lifting or Valsalva manoeuvre
• Avoid alcohol and hot drinks
• Avoid lying flat
• Monitor BP