Epistaxis (nosebleed)

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Epistaxis (nosebleed) Etiology 1? Local
causes 1)Traumamucosa laceration
blood vessel injury 2)Inflammation of
nose and sinus 3)Diseases of septum 4)Tumornasal
cavity tumor sinus tumor
angiofibroma of nasopharynx
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2? General factors Systematic disease Ascension
of arterial pressure and venous
pressure, Dysfunction of coagulation, Change of
blood vessel tension.
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1) Acute epidemical diseases 2) Cardiovascular
diseases 3) Hemological diseases 4) Nutrition
defectVitC?K?P or calcium 5) Liver, kidney
diseases and rheumatic fever 6) Poison
phosphorus, mercury, arsenic, benzene 7) Oslers
disease hemorrhagic familial telangiectasia 8)
Endocrinic imbalance
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Treatment 1? Fundamental treatment
Emergency sedation estimate the bleeding
amount keep proper posture No blood
ingest 2? Hemostatic methods 1)Identify the
bleeding site pinch the nostrils
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• 2)Cautery techniques
• chemical
• electrical
• laser
• radiofrequency
• microwave
• 3) Nasal packing
• resorbable material, gel foam.
• anterior
• postorior
• water or air balloon

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3?Artery ligation anterior ethmoid
artery posterior ethmoid artery internal
maxillary artery
external carotid artery 4? Angiography and
embolization submucous resection endoscopic
cautery and ligation
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5? Systematic management. 1) sedative 2)
hemostatic agent 3) Vitamine C,
K. 4)sclerosant 5) anti-shock management 6)Traditi
onal Chinese Medicine
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Foreign body in the nose
Endogenic Dead bone, blood clot,
rhinolith Extrogenic Plant seeds, insect, metals,
stone, woods Biologic Nonbiologic
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Etiology 1?Children 2-3yrs old 2?Insects 3?Injury
wood, rocks, metals 4?Iatrogenic
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Metal in nasal cavity
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Rhinolith in nasal cavity
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Diagnosis Unilateral purulent drainage with foul
smell in children Foreign body in the nose?
History nasal examination plain X-ray CT scan
Treatment Remove foreign body in different
ways Prevent foreign body in the nose?in bronchi
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Mucocele and Cyst
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Cyst of nasal vestibule

• Vestibule, maxillary dental alveoli, unilateral
  round/oval cyst
• Diagnosis
• palpation, punction
• X-ray
• Treatment
• resection of cyst

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Mucocele Benign neoplasms Obstruction of sinus
ostia and accumulation of fluid Etiology chronic
inflammation, allergic sinonasal disease, trauma,
and previous surgery Pathologyretention of
intrasinus secretion, progressive augmentation of
internal pression, bony remodeling and erosion.
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Morbidity China ethmoid gt frontal gt sphenoid gt
maxillary Abroad frontal gt ethmoid gt sphenoid gt
maxillary Symptoms Sign Orbital apex
syndrome Facial protrude Rhinorrhea, nasal
obstruction, hyposmia Diagnosis History,
symptoms and sign Punction, X-ray/CT
scan Treatment Operation open surgery,
marsupialization
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Diagnosis X-ray and CT scanner. Treatmentsu
rgical treatment drainage, creation of vast
communication with nasal cavity
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Tumor of nose and skull base Benign tumor in the
nose 40 kinds of benign tumor nasal organ is
small, difficult to identify the
origin. recurrence and malignant
transformation Hemangioma Capillary
hemangiomanasal septum anterior inferior
turbinate Cavernous hemangiomamaxillary nasal
bone
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Papilloma in the nose Pathogenesis unclear
humon papilloma virus (HPV) Pathology 1)
Keratotic papilloma simple cutaneous wart,
exophytic with broad base, in the nasal
vestibule or nasal septum.
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2) Inverted papilloma Agegt40ys,high morbidity
5060ys M F31 FeaturesHyperplastic
epithelia with inverting pattern of growth.
Epithelial inversion into underlying stroma.
Basal membrane is intact. Malignant
transformation 5-15 . squamous cell
carcinoma, adenocarcinoma.
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Symptoms Signs Nasal obstruction, rhinorrhea
with blood staining, sometimes with headache and
abnormalities of smell. Firm red or grey masses,
unilateral, arising from lateral wall of the
nose, extension into the ethmoid and maxillary
sinuses.
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Treatment Complete excision Some times it is
difficult. Recurrence 28-74 Lateral
rhinotomy. Endoscopic excision, with reasonable
recurrence rates. Malignant transformation--radiot
herapy
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Malignant tumor of nasal cavity and paranasal
sinuses Morbidity in China 2.05-3.66 of
malignant tumors in all 21.74-49.22 of
malignant tumors in ORL Carcinomacancer8.51 M
F1.5-3.01 Cancer---40-60ys,Sarcoma---younger
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24 of whole body carcinorna. more
frequently in sinus than nasal cavity
maxillary 6080 ethmioid 3.8
frontal 2.5 for advanced case
difficult to identify the original
site. Squamous 7080 more in maxillary
sinus Adenocarcinoma 48 more in ethmoid sinus
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Adenoid cystic carcinoma 4 more in ethmoid
sinus Sarcoma 10-20 malignant tumors in
ORL More in nasal cavity and maxillary
sinus. Malignant lymphomagt60
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Malignant epithelia tumor. Carcinoma of
nasal vestibule and Septum Carcinoma of the
paranasal Sinus Melanoma Esthesioneuroblasto
ma
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Malignant nonepithelial tumor.
Rhabdomyosarcoma. Hemangiopericytoma
lymphoma Extramedullary plasmacytoma.
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Symptoms Signs Nasal Cavity nasal
obstruction. epistaxis. pain. numbness
of cheek.
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Paranasal sinus purulent drainage with
blood nasal obstruction (unilateral,
progressive) extrusion of cheek extrusion
of hard palate Ophthalmologic symptoms
proptosis, epiphora, visual acuity
decrease, orbital apex syndrome
cranial involvement
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Diagnosis Caution! gt40yrs, unilateral,
progressive symptoms increase doctors index
of suspicion nasal examination nasal
endoscopic examination biopsy CT?MRI PET
(positron emission tomograph)
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• Treatment
• Radiotherapy 5000-6000rad within 4-8w,6w after
  radiotherapy --- surgery
• Surgery --- cornerstone
• -lateral rhinotomy.
• -midfacial degloving
• -Maxillectomy
• -Maxillectomyorbital contents exenteration
• -Craniofacial resection.

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3. Chemotherapy --- unwilling or unsuitable for
surgery Prognosis Survival advantage
radiation and surgery. The value of the
chemotherapy undetermined. 5yr survival
rate 30-40 for maxillary sinus MT
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