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EPISTAXIS Dr Muhammad Zaman Qureshi ER Resident Mowqaq General Hospital Mowqaq 18/7/1434 Epistaxis is a latin word means bleeding from the nose. Seen in all age groups. Presents as an emergency. Epistaxis is a sign and not a disease per se. BLOOD SUPPLY OF NOSE : Nose is richly supplied by both the external and internal carotid systems, both on the septum and the lateral walls. Nasal septum : Internal carotid system : Anterior ethmoidal artery Posterior ethmoidal artery Branches of ophthalmic artery EPISTAXIS External carotid system : Sphenopalatine artery (branch of maxillary artery), gives nasopalatine and posterior nasal septal branches. Septal branch of greater palatine artery (Br. of maxillary artery). Septal branch of superior labial artery (Br. of facial artery). Lateral wall : Internal carotid system : Anterior ethmoidal Posterior ethmoidal Branches of ophthalmic artery External carotid system : Posterior lateral nasal Greater palatine artery Nasal branch of anterior superior dental Branches of facial artery to nasal vestibule ? ? ? From sphenopalatine artery From maxillary artery From infraorbital branch of maxillary artery Little’s area : It is situated in the anterior inferior part of nasal septum, just above the vestibule. Four arteries 1.anterior ethmoidal 2. septal branch of superior labial 3. septal branch of sphenopalatine and 4. greater palatine, anastomose here to form a vascular plexus called “Kiesselbach’s plexus”. This area is exposed to the drying effect of inspiratory current and to finger nail trauma, and is the usual site for epistaxis in children and young adults. Kiesselbach’s Plexus/Little’s Area: -Sphenopalatine A - -Greater Palatine A -Superior Labial A -Anterior Ethmoid (Opth) Woodruff’s Plexus: -Pharyngeal & Post. Nasal branches of Sphenopalatine Retrocolumellar vein : This vein runs vertically downwar