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Epistaxis is defined as bleeding from the nose and
is one of the commonest emergencies dealt with by
the otolaryngologist. The overall incidence of epi-
staxis in the general population is difficult to deter-
mine because most cases are unreported, minor,
self-limiting episodes or those controlled with sim-
ple first-aid measures. Fewer than 10% of patients
seek medical attention for epistaxis and fewer than
10% of those requiring hospitalisation require sur-
gical intervention for control of bleeding.
Due to the fact that many cases involve the
elderly population, epistaxis is a significant cause
of morbidity and even mortality in general oto-
laryngology practice. In England there were
22,671 admissions in 2014/2015, with a mean stay
of two days.
The nose has an excellent blood supply from both
the internal and external carotid arteries, which
anastomose extensively within the lateral wall of the
nose and septum. The external carotid artery sup-
plies the nose via the facial and maxillary branches.
The maxillary artery supply is via the sphenopala-
tine and greater palatine branches and the facial
artery supply is mainly via the superior labial artery.
The sphenopalatine artery is the most important
blood supply to the nose and it enters the nose via
the sphenopalatine foramen before dividing into the
posterior septal artery, which runs medially across
the face of the sphenoid to the posterior septum and
subsequently Little’s area, and the posterior lateral
division, which supplies the inferior and middle
turbinate. The internal carotid artery contributes
the anterior and posterior ethmoid arteries via the
ophthalmic artery, and supplies the superior part of
the nasal septum and lateral wall. |
