EPISTAXIS

EPISTAXIS

The causes of epistaxis are listed in Table 51.2 . The most common site of bleeding is from Kiesselbach’s plexus in Little’s area of the anterior portion of the septum ( Figure 51.37 ). Anterior bleeding is common in children and young adults owing to nose blowing or picking. In the elderly , anticoagulants and hypertension are the underlying causes of arterial bleeding from the posterior part of the nose. Hereditary haemorrhagic telangiectasia (HHT) (Osler’s dis ease) gives rise to recurrent multifocal bleeding from thin-walled vessels deficient in muscle and elastic tissue ( Figure 51.44 Juvenile angiofibroma is an uncommon condition that a ff ects adolescent boys and may lead to massive life-threatening episodes of b leeding. Diagnosis is made with contrast CT or MRI. Anterior bowing or indentation of the posterior antral wall (Holman–Miller or antral sign) is the classical finding but may be seen in other expansive lesions in this ar ea. It is a very vascular tumour, which should not be biopsied because of the risk of uncontrollable haemorrhage. Excision is best carried out by an experienced surgeon and is usually performed endoscopically , often using image guidance ( Figure 51.45 Preoperative embolisation of the feeding blood vessels may help to reduce blood loss during surgery . /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF

Figure 51.43 Silastic prosthesis for septal perforation. TABLE 51.2 Causes of epistaxis. Local Nose picking Nasal trauma Nasal foreign bodies Tumours Infection Granulomatous disorders Juvenile angio /f_i broma Systemic Hypertension Warfarin therapy New anticoagulants (rivaroxaban) Aspirin, clopidogrel therapy Haemophilia von Willebrand’s disease Leukaemia Hereditary haemorrhagic telangiectasia (Osler’s disease)

EPISTAXIS

The causes of epistaxis are listed in Table 51.2 . The most common site of bleeding is from Kiesselbach’s plexus in Little’s area of the anterior portion of the septum ( Figure 51.37 ). Anterior bleeding is common in children and young adults owing to nose blowing or picking. In the elderly , anticoagulants and hypertension are the underlying causes of arterial bleeding from the posterior part of the nose. Hereditary haemorrhagic telangiectasia (HHT) (Osler’s dis ease) gives rise to recurrent multifocal bleeding from thin-walled vessels deficient in muscle and elastic tissue ( Figure 51.44 Juvenile angiofibroma is an uncommon condition that a ff ects adolescent boys and may lead to massive life-threatening episodes of b leeding. Diagnosis is made with contrast CT or MRI. Anterior bowing or indentation of the posterior antral wall (Holman–Miller or antral sign) is the classical finding but may be seen in other expansive lesions in this ar ea. It is a very vascular tumour, which should not be biopsied because of the risk of uncontrollable haemorrhage. Excision is best carried out by an experienced surgeon and is usually performed endoscopically , often using image guidance ( Figure 51.45 Preoperative embolisation of the feeding blood vessels may help to reduce blood loss during surgery . /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF

Figure 51.43 Silastic prosthesis for septal perforation. TABLE 51.2 Causes of epistaxis. Local Nose picking Nasal trauma Nasal foreign bodies Tumours Infection Granulomatous disorders Juvenile angio /f_i broma Systemic Hypertension Warfarin therapy New anticoagulants (rivaroxaban) Aspirin, clopidogrel therapy Haemophilia von Willebrand’s disease Leukaemia Hereditary haemorrhagic telangiectasia (Osler’s disease)