It is the simplest treatment for the nose bleed by pinching the ala nasi.
UNDERSTANDING VASCULAR ANATOMY
Both the internal and external carotid arteries supply the nose via branches which anastomose extensively within the lateral wall, septum and across the midline.
KEY CLINICAL AREAS
Little’s area or Kiesselbach plexus or Locus Valsalvae
The most important identified arterial plexus on the anterior septum.
Frequent site of anterior bleeding.
It is a venous plexus of prominent blood vessels lying just inferior to the posterior end of the inferior turbinate.
It is a frequent source of posterior epistaxis in adults.
Portal of major arterial supply to nasal cavity
Formed by U-shaped notch in the vertical portion of the palatine bone which is closed posterosuperiorly by sphenoid bone.
Transmits: sphenopalatine artery, vein and nasal palatine nerve ( maxillary division of trigeminal nerve).
Lateral to it lies the pterygopalatine space.
“Crista Ethmoidalis” is a small bony projection which lies anterior to the foramen in 96% of cases and is the landmark to lacate the foramen during ESPAL.
CLASSIFICATION OF EPISTAXIS
AETIOLOGICAL FACTORS OF ADULT EPISTAXIS:
Weather: winter and autum
Tilt the head forward ( Do not tilt backward as this will cause swallowing leading to vomiting and aspiration)
Pinch the ala nasi at least for 5-10 minutes continuously with thumb and the index finger.
Seek for medical help if it doesn’t stop.
WHICH ARTERY IS THE ARTERY OF EPISTAXIS?
The Sphenopalatine artery is the most important supply to the nasal cavity
WHAT IS THE WATERSHED BETWEEN INTERNAL AND EXTERNAL CAROTID CIRCULATION IN NASAL CAVITY?
The middle turbinate and corresponding imaginary line of demarcation at the same level on the nasal septum marks the clnical dividing landmark between the internal and external carotid artery distribution.
WHAT IS THE INCIDENCE OF SEPTAL BLEEDING, LATERAL WALL AND NOT LOCATED?
Septal bleeding: 70 %
Lateral wall: 24% ( superior t & m= 4 %, middle t & m= 12, inferior t & m= 8% )
Unlocated: 6 %
WHAT ARE THE APPROACHES OF ANTERIOR ETHMOIDAL ARTERY LIGATION?
External ( medial canthal ) approach
Endoscopic ( transethmoidal ) approach
WHY IS THE INFERIOR TURBINECTOMY FOLLOWED BY A SEVERE SECONDARY EPISTAXIS AS A COMPLICATION? HOW DO YOU CONTROL IT?
At its origin, the artery runs anteroinferiorly in the submucosa where it is very vulnerable to damage during radical turbinectomy.
On reaching the inferior turbinate, it divides into 3 parallel branches which run in bony tunnels within the substance of the turbinate. These tunnels with their periarterial cuff of fibrous tissue and venous elements may prevent the artery constricting following turbinectomy. Thus may predispose to postoperative haemorrhage.
We should direct attempt to control haemorrhage towards posterosuperior aspect of inferior turbinate where pressure bipolar to the submucosal segment of artery should prove effective.