ABSTRACT

Epistaxis is one of the commonest emergencies dealt with by the otolaryngologist and is a significant cause of morbidity and even mortality. 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. Epistaxis can be classified anatomically into anterior (Kiesselbach’s plexus) or posterior (Woodruff’s plexus), or perhaps more usefully, based on aetiology and whether it is primary or secondary. Epistaxis should be managed in a logical sequence, and this is described in the chapter. Direct therapy to the bleeding point, such as cautery, is the optimum management in primary epistaxis. If no bleeding point is identified, indirect therapies can be employed, including nasal packing. The management of refractory epistaxis is discussed and, in particular, the use of haemostatic agents, arterial ligation and embolisation. Secondary epistaxis can be challenging to manage and requires treatment of the underlying cause and avoiding instrumentation of the nose as much as possible, as this can exacerbate the problem.