Epistaxis


Bleeding from inside the nose is called epistaxis. It is fairly common and is seen in all age groups children, adults and older people. It often presents as an emergency. Epistaxis is a sign and not a disease per se and an attempt should always be made lo find any local or constitutional cause.
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

(a) Anterior ethmoidal artery. Branches of
(b) Posterior ethmoidal artery. \ ophthalmic artery
External Carotid System
(a) Sphenopalatine artery (branch of maxillary artery),gives nasopalatine and posterior nasal septal branches.
(b) Septal branch of greater palatine artery (Br. of maxillaryartery).
(c) Septal branch of superior labial artery (Br. of facialartery).
Lateral Wall

Internal Carotid System



(a) Anterior ethmoidal Branches of
(b) Posterior ethmoidal ophthalmic artery

External Carotid System

(a) Posterior lateral nasal branches -> From Sphenopalatine
artery
(b) Greater palatine artery -> From maxillary artery
(c) Nasal branch of anterior superior dental -> From infraorbitalbranch of maxillary artery
(d) Branches of facial artery to nasal vestibule

Little's Area


It is situated in the anterior inferior part of nasal septum, just above the vestibule. Four arteries—anterior ethmoidal, septal branch of superior labial, septal branch of Sphenopalatine and the greater palatine, anastomose 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.

Retrocolumellar vein.

This vein runs vertically downwards just behind the columella, crosses the floor of nose and joins venous plexus on the lateral nasal wall. This is a common site of venous bleeding in young people.


Causes of Epistaxis