Dr Sari Wulan, SpTHT-KL

Department of Otorhinolaryngology - Head &

Neck Surgery.
Udayana University Faculty of Medicine,
Sanglah General Hospital Denpasar

Perdarahan:

- a. etmoid anterior
- a. etmoid posterior
- a. sfenopalatina
- cab. a. fasialis
- pleksus Kiesselbach anyaman pembuluh
darah septum, letak superfisial, mudah
cedera
Vena = nama arteri, bermuara ke v. optalmika >
sinus kavernosus. Vena tidak memiliki katup

Epistaxis: from the Greek word: epi (on) stazo (to

fall in drop) bleeding from the nose
Severity of epistaxis:
Mild, anterior bleeding that resolves
spontaneously
Severe, posterior bleeding with hypotension,
anemia and airway compromise that lead to
death

Etiology:
Local:
o Trauma: digital, fracture
o Nasal spray
o Inflammatory reaction
o Anatomic deformities
o Foreign bodies
o Intranasal tumors
o Chemical inhalants
o Surgery

Systemic:
o Vascular disorders
o Blood cell anomalies
o Blood cell malignancies
o Allergies
o Malnutrition
o Alcohol
o Hypertension
o Drugs
o Infection

 Anterior bleeding: bleeding from anterior part of

septum (Littles area) and anterior ethmoid

artery.
Little area/ Kiesellbach plexus most frequent
area of bleeding
Posterior bleeding: bleeding from posterior

ethmoid artery, sphenopalatine artery.

Bleeding commonly severe

Management:
Stop the bleeding; identified bleeding point after
cleaning the nasal cavity.
put lidocain & adrenalin gauze for 5 - 10 minutes in
nasal cavity
o When the bleeding stop, bleeding point

cauterization by AgNO3 20-30%, tri chlor acetic

acid 10% or electrocautery

o When bleeding still profuse packing nasal cavity

with ribbon gauze for 2 days .

o When bleeding still occur, packing with posterior
packing ( Belloq )
o When bleeding still occur, ligation of artery
artery: - anterior ethmoidal artery
- posterior ethmoidal artery
- internal maxillary artery
- sphenopalatine artery
- external carotid artery

Prevention of complication
Complication can occur:
- direct from bleeding: shock
treatment: intra venous fluid drip or
transfusion
- effect of gauze packing: infection: middle
ear infection, sinusitis
treatment: oral antibiotic

Prevention for relapse.

Epistaxis only symptom, importance to detect
cause of epistaxis.
If the disease treatable, epistaxis can not
relapse