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Congenital Nasal Disorders
Published in Raymond W Clarke, Diseases of the Ear, Nose & Throat in Children, 2023
Some degree of deviation of the nasal septum is so common as to be normal. This may be due to compression of the facial skeleton at delivery. Unless there is gross cosmetic deformity or severe airway obstruction, nasal septal surgery is usually discouraged before the mid to late teens due to the risk of a poor aesthetic result (‘saddle nose’). Prominent blood vessels on the nasal septum (Little’s area or Kiesselbach’s plexus) can cause nosebleeds (epistaxis) but in children a dilated vein just under the septal mucosa can be to blame. This usually responds well to silver nitrate cautery.
Head and Neck
Published in Bobby Krishnachetty, Abdul Syed, Harriet Scott, Applied Anatomy for the FRCA, 2020
Bobby Krishnachetty, Abdul Syed, Harriet Scott
The overall arterial supply of the nose is by branches of internal and external carotid arteries. External nose – branches of facial, ophthalmic and maxillary arteriesLateral nasal wall – sphenopalatine, anterior and posterior ethmoid arteriesNasal septum – sphenopalatine, anterior and posterior ethmoid arteries and superior labial and the greater palatine arteries. Little’s area or Kiesselbach’s plexus is situated in the antero-inferior part of nasal septum just above the vestibule and marks the confluence of different supplies (Figure 1.9).
Answers
Published in Andrew Schofield, Paul Schofield, The Complete SAQ Study Guide, 2019
Andrew Schofield, Paul Schofield
Epistaxis is the major ENT emergency. It is classified as anterior or posterior. Anterior epistaxis comprises the majority of cases, with bleeding often occurring from Little’s area (otherwise known as Kiesselbach’s plexus). This is the areas where the anterior ethmoidal, sphenopalatine and facial arteries anastamose. As with any emergency presentation, an ABCDE approach should be taken to initial management. The patient may require resuscitation with IV fluids and/or red blood cell transfusion. Obvious anterior bleeding sites may be cauterised but otherwise may require anterior packing. Posterior epistaxis may be more difficult to cauterise and can be managed by inflation of a balloon/foley catheter in addition to an anterior nasal pack. Ligation/embolisation of the arterial source is an alternative if the above measures fail to control the bleeding.
Low-intensity diode laser combined with nasal glucocorticoids in the treatment of recurrent epistaxis in children: a randomized controlled trail
Published in Acta Oto-Laryngologica, 2023
Shuyue Wang, Haiyao Zheng, Tao Liao
Evaluation of efficacy in epistaxis treating: Complete remission: after treatment, mucosal crust or bleeding points in the Kiesselbach plexus disappeared under observation by nasal endoscopy. Meanwhile, no recurrence of epistaxis occurred 2 months after the first treatment. Partial remission: after treatment, mucosal crust or bleeding points in the Kiesselbach plexus are relieved under observation by nasal endoscopy. Meanwhile, the bleeding frequency or volume reduced 2 months after the first treatment. Ineffectiveness: After treatment, mucosal crust or bleeding points in the Kiesselbach plexus were unchanged under observation by nasal endoscopy. Meanwhile, the frequency or the volume of bleeding was unchanged in 2 months after the first treatment. Exacerbation: After treatment, mucosal crust or bleeding points in the Kiesselbach plexus aggravated under observation by nasal endoscopy. Meanwhile, the bleeding frequency or volume increased 2 months after the first treatment. Both Complete remission and Partial remission were considered effective results.