Medial wall/nasal septum (nasal septum)

Lateral wall

Roof wall: the anterior section is the nasal part of the frontal bone and the dorsal surface of the nasal bone; the middle section is the cribriform plate; the posterior section is the anterior wall of the sphenoid sinus

Base wall: Palatine process of maxilla, horizontal part of palatine bone

Ophthalmic artery: Anterior ethmoid artery (anterior ethmoid sinus, frontal sinus, lateral wall of the nasal cavity, and anterior and upper part of the nasal septum) Posterior ethmoid artery (posterior ethmoid sinus, lateral wall of the nasal cavity, and posterior and upper part of the nasal septum)

Maxillary artery: The sphenopalatine artery that originates is the main blood supply artery of the nasal cavity, and can be divided into lateral branches (including the lateral posterior nasal artery → the posterior and lower part of the lateral wall of the nasal cavity and the floor of the nasal cavity), and medial branches (including the posterior septal artery → posterior nasal septum) lower part)

①Anterior wall: The canine fossa is in the center, and the infraorbital foramen is above;

②Posterior outer wall: adjacent to the pterygopalatine fossa and infratemporal fossa; in severe epistaxis, the maxillary artery can be ligated through this wall;

③Inner wall: middle meatus and lateral wall of inferior meatus;

④Upper wall: bottom of orbit;

⑤Bottom wall: Maxillary alveolar process

Trauma: If the anterior ethmoid artery, internal carotid artery, or pseudoaneurysm ruptures and bleeds, it can be life-threatening.

Inflammation: non-specific inflammation, specific inflammation (such as rhinosclerosis, tuberculosis)

Nasal septum diseases: deviated septum, septal ulcer, septal perforation

Tumors: including tumors in the nasal cavity, paranasal sinuses, and nasopharynx; the amount of bleeding in the early stage is generally small, but it can occur repeatedly; in the late stage, fatal bleeding may occur if large blood vessels are destroyed

Foreign body in nasal cavity

Cardiovascular disease: Elevated/fluctuated arterial pressure is common. Pulsating bleeding can be seen in areas prone to bleeding. People who occur in the back of the nasal cavity have a large amount of bleeding but it is difficult to stop the bleeding.

Chronic diseases of liver and kidneys

Hematological diseases: mainly bleeding, often bilateral, accompanied by bleeding in other parts of the body

Endocrine disorders: especially bleeding in women during compensatory menstruation, pregnancy, and menopause

Acute febrile infectious diseases: Bleeding usually occurs due to congestion and dryness of the nasal mucosa, mostly in areas prone to bleeding.

Severe malnutrition and vitamin deficiency: causing changes in blood vessel fragility and affecting coagulation function

Chemical and drug poisoning: caused by damage to the function of the hematopoietic system

Hereditary hemorrhagic telangiectasia: more common in bilateral nasal septum submucosal

Sedation, taking medical history, determining the amount/cause of bleeding

Use 1% ephedrine cotton pads/oxymetazoline/0.1% epinephrine cotton pads to temporarily stop bleeding, and use a suction device to find the bleeding site under the rhinoscope/endoscope and stop the bleeding.

Acupressure method: suitable for those with small bleeding volume and the bleeding site is in the Little area

Packing method: the most effective and commonly used; suitable for those with severe bleeding, large bleeding area or unknown bleeding site; including anterior nostril packing method and posterior nostril packing method; note that the packing material is usually removed after 48 to 72 hours

Cautery method: suitable for patients with repeated small amounts of bleeding and clear bleeding points

Hemostasis under nasal endoscopy: less painful, accurate and rapid hemostasis, and good effect

Vascular ligation method: suitable for large vessel bleeding caused by repeated tamponade and medical hemostasis treatment, trauma/surgery; commonly used external carotid artery ligation (between superior thyroid artery and lingual artery), anterior ethmoid artery ligation; but coagulation dysfunction Caused by the ban

Vascular embolization method: It is suitable for refractory epistaxis after effective repeated packing method/nasal endoscopic treatment is ineffective, severe bleeding of large blood vessels caused by trauma/surgery, and ruptured pseudoaneurysm; but it cannot be used to control the rupture of pseudoaneurysm caused by the anterior ethmoid artery and ethmoid artery. epistaxis due to posterior artery

Rest in a semi-recumbent position, nutritional support (including vitamin supplements), fluid rehydration, and appropriate use of hemostatic agents

Recurrent bleeding from Little's area: local injection of sclerotherapy, submucosal septal dissection/scarification

Deviated nasal septum: correction surgery

Hereditary hemorrhagic telangiectasia: septoplasty

symptom

examine

Surgical treatment

Characteristics: Mostly caused by direct violence; anterior wall fractures are the most common, which may only manifest as epistaxis and soft tissue swelling and pain; comminuted fractures may cause swelling of the supraorbital area, subcutaneous pneumatosis, posterior displacement of the superior orbital rim, and downward movement of the eyeball; posterior wall fractures may be caused by Wall fractures are often accompanied by meningeal tears and even intracranial complications.

treat:

Characteristics: cerebrospinal fluid rhinorrhea, uncontrollable epistaxis and intraorbital hemorrhage (damage to the anterior ethmoid artery), eyeball displacement and vision loss may occur; often accompanied by nasal bone and orbital damage (nasoorbital ethmoid fracture)

Treatment: Simple ethmoid bone fractures do not require special treatment; extranasal anterior ethmoid artery ligation can be performed when tamponade is ineffective for severe epistaxis. Severe vision loss that occurs quickly after injury should require optic canal decompression as soon as possible.

Characteristics: Depressed fractures are more common in the anterior wall, especially around the frontal process of the maxillary sinus and the infraorbital foramen; manifested by local swelling, collapse, deformity, and maxillofacial asymmetry on the left and right sides (especially after the swelling subsides) ; often part of a compound maxillofacial fracture

Treatment: Depressed fractures of the anterior wall can be reduced through radical maxillary sinus surgery.

Characteristics: Often part of skull base fracture (such as longitudinal temporal bone fracture); vision loss, blindness, and fatal bleeding may occur when the optic canal and internal carotid artery are involved.

Treatment: No treatment is required for simple sphenoid sinus fractures without complications.

Conservative treatment

Surgical treatment

Foreign bodies in the nasal cavity of children: multiple unilateral nasal discharge with mucopurulent discharge, blood in the discharge, nasal congestion, and smelly exhaled breath

Traumatic foreign body on the face: In addition to trauma, symptoms vary depending on the size, nature, residence time and location of the foreign body.

Animal foreign bodies: There is often a crawling sensation in the nose, which may lead to sinusitis over time.

Iatrogenic foreign body: Severe nasal congestion, purulent secretions, and headaches remain after surgery

If the foreign body remains for a long time and granulation tissue is formed in the nose, a probe must be used to assist the examination; metal foreign bodies should be examined with X-rays and CT if necessary.