Epistaxis(nosebleed)

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Epistaxis(nosebleed)
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Epistaxis

• Synonyms nasal hemorrhage, nose bleed,
  bosebleed, bloody nose.
• Background nosebleed is defined as acute
  hemorrhage from the nostril, nasal cavity,
  nasopharynx. In the majority of the cases,
  bleeding is in small quantities and self-limited,
  sometimes it can be very intense and
  life-threatening.
• Incidence with peak in those aged 2-10 years
  and 50-80 years. No sex predilection.
• Climates factor nose bleed most common occurs
• during colder month and in dry colder climates

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Epistaxis

• Pathophysiology
• ? Primary bleeding site
• anterior is common. Posterior
• is rare
• ? Littles area is most
• commonly bleeding site (Kieselbach plexus)
• ? Posterior bleeding usually
• originate below the posterior
• half of the inferior turbinate or
• roof of the nasal cavity.

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Epistaxis

• Cause
• Local causes
• ? Trauma fracture of nasal bone
• ? Infection viral rhinitis, acute rhinitis.
• ? Foreign bodies
• ? Deviation of the nasal septum
• ? Atmospheric change, dry climates
• ? Tumors in nasal cavity and sinuses

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Epistaxis

• General Causes
• ? hypertension and heart diseases
• ? pregnancy
• ? Acute general infection
• ? Drugs abuse
• ? Diseases of blood system

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Epistaxis

• Diagnostic step
• 1.history
• 2.localize bleeding site
• 3.determine causes
• 4.measurement of blood pressure
• 5.analysis of blood coagulation
• 6.radiograph or CT image

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Epistaxis

• Treatment
• Digital press 10 minutes
• Cautery AgNO3 , laser,
• microwave
• Hardener injection 40 urea
• Nasal packing
• vaseline gauze,
• balloon
• glutin sponge
• compressed sponge

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Epistaxis
Traditional packing Vaseline gauze ribbon for
2448 hours Prevent infection of sinus with
antibiotic
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Epistaxis
The step of posterior nasal
packing
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Epistaxis

• Vascular ligation
• this procedure is used for uncontrolled
  life-threatening epistaxis
• external carotid artery(ECA) often be
  ligated because most nosebleed site is the area
  supplied with the branch of ECA .
• Calming the patient
• Lowering of blood pressure
• Discontinuation of anticoagulation
• Administration of fluid expanders

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Epistaxis

• How to prevent rebleeding after initial bleeding
  has stopped
• Do not pick or blow nose.
• Do not strain or bend down to lift anything
  heavy.
• Keep head higher than the heart.
• Use a humidifier during dry winter months
• A saline nasal spray will also moisten dry nasal
  membranes.

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Cancer of the nose and sinus
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Cancer of the nose and sinuses

• General situation
• cancers of nose and sinuses occupy less than
  1 of all malignancies and about 3 of all head
  and neck cancer. The aetiology is unknown.
• Aetiology
• Definite factor dust from hard woods,
  nickel
• 99 tumor affect the maxillary and ethmoid
  sinuses,
• only 1 tumor affect the frontal and
  sphenoid sinuses

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Cancer of the nose and sinuses

• Pathology
• 80 of tumor are squmous cell cancer.
• 10 of tumor are adenocarcinoma or adenoid
  cystic carcinoma
• 1 of nasal tumor are melanomas.
• sarcomas are rare, but in our depatment, we
  had once treated some patients with
  rhabdomyosarcoma. Most of them are children
• recently, the malignant lymphoma in nose and
  sinuses often
• treated by ENT doctors.

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Cancer of the nose and sinuses

• Clincal features
• 1.Squmous-cell cancer or basal-cell cancers
  usually affect the nasal skin.
• 2.Squmous-cell cancer grow faster and may
  metastasize to the neck at any stage. basal-cell
  cancers grow slowly and and then gradually spread
  locally, they do not metastasize. But in advance
  stage, they can erode the nose and adiacent cheek
  .
• 3. It is difficult to distinguish tumor
  origination from maxllary sinuses or ethmoid
  sinuses.

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Tumor invading and clinical symptom
? Erode orbital floor diplopia, proptosis
? invade the face cheek bulged, numbness
? enter nasal cavity tears, obstruction
Bloody discharge
? erode tooth and palatine oral cavity
? invade pterygopalatine fossa
trismus
Invasion of nerves will cause headache,
numbness in the face or palate
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Cancer of nose and sinuses
Tumor of ethmoid sinus
Cancer of maxillary sinus
Nasal cancer
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Diagnosis

• biopsy and X-ray, CT, MRI confirmation

Malignant teratoma
Ossifying fibroma
Undifferentiated cancer
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Treatment

• Surgical excision maxillectomy
• Radiotherapy
• Chemotherapy
• Combination therapy

Malignant fibrohistocystosis