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Article contents
Does epistaxis with an unknown bleeding site originate from the posterior part of the nasal cavity?
Published online by Cambridge University Press: 22 August 2019
Abstract
Objective
To review the origins of epistaxis in patients with unknown bleeding sites.
Methods
This consecutive case series included 26 patients with unknown bleeding sites previously considered to have posterior epistaxis. All patients had previously been examined endoscopically at least once, and were again examined with 30°, 45° and 70° endoscopes.
Results
The bleeding site was at the: anterior end of the lateral wall of the inferior meatus in one patient (3.8 per cent); anterosuperior lateral wall of the nasal cavity in five patients (19.2 per cent); anterior nasal cavity roof in seven patients (26.9 per cent); anterosuperior part of the cartilaginous septum in nine patients (34.6 per cent); ostium pharyngeum tubae in two patients (7.7 per cent); and anterior nasal base in two patients (7.7 per cent). The morphology of the bleeding point showed: nasal mucosa ulceration in 1 patient, isolated primary telangiectasia in 3 patients, prominent vessels in 5 patients and capillary angioma in 17 patients.
Conclusion
Epistaxis originating from the anterosuperior nasal cavity and nasopharynx can be easily misdiagnosed as posterior epistaxis or unknown bleeding sites. Areas that should be considered as possible origins of epistaxis in cases with unknown bleeding sites were identified.
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- Copyright
- Copyright © JLO (1984) Limited, 2019
Footnotes
Dr Z-C Lou takes responsibility for the integrity of the content of the paper
References
1Chiu, TW, McGarry, GW. Prospective clinical study of bleeding sites in idiopathic adult posterior epistaxis. Otolaryngol Head Neck Surg 2007;137:390–3Google Scholar
2Thornton, MA, Mahesh, BN, Lang, J. Posterior epistaxis: identification of common bleeding sites. Laryngoscope 2005;115:588–90Google Scholar
3Iimura, J, Hatano, A, Ando, Y, Arai, C, Arai, S, Shigeta, Y et al. Study of hemostasis procedures for posterior epistaxis. Auris Nasus Larynx 2016;43:298–303Google Scholar
4Bhatnagar, RK, Berry, S. Selective Surgicel packing for the treatment of posterior epistaxis. Ear Nose Throat J 2004;83:633–4Google Scholar
5Almeida, GS, Diógenes, CA, Pinheiro, SD. Nasal endoscopy and localization of the bleeding source in epistaxis: last decade's revolution. Braz J Otorhinolaryngol 2005;71:146–8Google Scholar
6Liu, J, Sun, X, Guo, L, Wang, D. Posterior epistaxis: common bleeding sites and prophylactic electrocoagulation. Ear Nose Throat J 2016;95:E18–22Google Scholar
7Paul, J, Kanotra, SP, Kanotra, S. Endoscopic management of posterior epistaxis. Indian J Otolaryngol Head Neck Surg 2011;63:141–4Google Scholar
8Shrestha, BL. Endoscopic sphenopalatine artery cauterization in recurrent posterior epistaxis: an experience at Dhulikhel Hospital, Kathmandu University Hospital. Kathmandu Univ Med J (KUMJ) 2014;12:85–6Google Scholar
9Hey, SY, Koo Ng, NKF, McGarry, GW. Endoscopic sphenopalatine artery ligation: general applicability in a teaching unit. Ear Nose Throat J 2019;98:85–8Google Scholar
10Yukitatsu, Y, Tsuzuki, K, Takebayashi, H, Sakagami, M. Clinical study of 1,515 patients presenting with epistaxis over the last 6 years. ORL J Otorhinolaryngol Relat Spec 2016;78:232–40Google Scholar
11Wei, W, Lai, Y, Zang, C, Luo, J, Zhu, B, Liu, Q et al. A blind area of origins of epistaxis: technical or cognitive? Eur Arch Otorhinolaryngol 2018;275:1501–5Google Scholar
12Zou, Y, Deng, YQ, Xiao, CW, Kong, YG, Xu, Y, Tao, ZZ et al. Comparison of outcomes between endoscopic surgery and conventional nasal packing for epistaxis in the posterior fornix of the inferior nasal meatus. Pak J Med Sci 2015;31:1361–5Google Scholar
13Stoddard, T, Loehrl, TA, Hunt, BC, Poetker, DM. Intractable epistaxis due to isolated primary telangiectasias. JAMA Otolaryngol Head Neck Surg 2014;140:160–3Google Scholar