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Anatomy/Physiology of Epistaxis
• Anatomy
– Nasal cavity – Vascular supply
• Physiology
– Vascular nature – Mucosa
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Why bleeding from the nose ?
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ቤተ መጻሕፍቲ ባይዱ
SPF -class I (35%) -class II (56%) -class III (9%)
Anatomy of the Lateral Nasal Wall
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External Carotid Artery -Sphenopalatine artery -Greater palatine artery -Ascending pharyngeal artery -Posterior nasal artery -Superior Labial artery
Internal Carotid Artery -Anterior Ethmoid artery -Posterior Ethmoid artery
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Pterygopalatine Vasculature --Internal maxillary artery
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Anatomy of the Nasal Cavity a2n02d0/8/4Vasculature
Sphenopalatine AA Ethmoid AA Greater Palatine A
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Kesselbach’s Plexus/Little’s Area:
-Anterior Ethmoid (Opth) -Superior Labial A (Facial) -Sphenopalatine A (IMAX) -Greater Palatine (IMAX)
Local Factors Infection/Inflammation
• Rhinitis/Sinusitis
– Allergic – Bacterial – Fungal – Viral
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Local Factors - Trauma
• Nose picking • Nose blowing/sneezing • Nasal fracture • Nasogastric/nasotracheal intubation • Trauma to sinuses, orbits, middle ear,
• Mythology: brown paper, nails, scissors, scarlet threads,“lead that has never touched the ground”
• A condition with a long history— Hippocrates to Henry Goodyear.
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Local Factors - Neoplasm
• Juvenile nasopharyngeal angiofibroma • Inverted papilloma • SCCA • Adenocarcinoma • Melanoma • Esthesioneuroblastoma • Lymphoma
Woodruff’s Plexus:
-Pharyngeal & Post. Nasal AA of Sphenopalatine A (IMAX)
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Anterior vs. Posterior
• Maxillary sinus ostium • Anterior: younger, usually septal vs.
• Local factors
– Vascular – Infectious/Inflammatory – Trauma (most common) – Iatrogenic – Neoplasm – Dessication – Foreign Bodies/other
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Etiology
base of skull • Barotrauma
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Nasal Fracture with Septal Hematoma
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Local Factors - Iatrogenic nasal injury
• Functional endoscopic sinus surgery • Rhinoplasty • Nasal reconstruction
anterior ethmoid, most common (>90%), typically less severe • Posterior: older population, usually from Woodruff’s plexus, more serious.
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Etiology
鼻出血(英文) PPT课件
Introduction and History
• 5-10% of the population experience an episode of epistaxis each year. 10% of those will see a physician. 1% of those seeking medical care will need a specialist.
• Systemic factors
– Vascular – Infection/Inflammation – Coagulopathy
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Local Factors -- Vascular
• ICA Aneurysms
– extradural – cavernous sinus
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Vascular organ secondary to incredible heating/humidification requirements • Vasculature runs just under mucosa (not squamous) • Arterial to venous anastamoses • ICA and ECA blood flow