Epistaxis

Epistaxis is a common problem that affects the whole population. The majority of cases are self-limiting and do not require any medical assessment or treatment. Epistaxis may not resolve with first aid measures, or the episodes may be frequent and thus the patient presents to emergency medicine or their general practitioner. Some patients require assessment and treatment by ENT, either in the outpatients clinic or require an unscheduled (emergency) admission to hospital. We provide an overview of the management of epistaxis in the outpatients clinic and during an unscheduled admission in paediatric and adult patients. We highlight the key considerations in the history and management, and the rare conditions to be aware of that are associated with epistaxis. Medical and surgical management are discussed. We will briefly outline first aid measures that can be performed by the patient and expected management of the patient in the community.     

Epistaxis

Epistaxis is extremely common and usually managed with simple first aid measures in the community. However it can also present with life-threatening haemorrhage which requires appropriate resuscitation and arrest of the bleeding. Of those patients presenting to local emergency services, knowledge of the assessment and management of epistaxis are essential. Epistaxis is classified as primary epistaxis, where no cause can be found or secondary epistaxis where there is a defined cause. It is also described in terms of the site of bleeding. Anterior bleeding from the nasal septum is found in 90% of cases and can be controlled with simple first aid measures or nasal packing and/or cautery. Posterior bleeding is more dramatic and may require a surgical procedure or radiological guided embolization. Many patients, particularly the elderly, have associated co-morbidities and medications that need to be addressed along with the standard treatment. This article discusses the assessment and appropriate management of patients with epistaxis and their associated morbidities.     

Endoscopic Identification of the Pharyngeal (Palatovaginal) Canal: An Overlooked Area

Objective The pharyngeal or palatovaginal canal (PC) is a small tunnel that lies between the sphenoid process of the palatine bone and the vaginal process of the sphenoid bone. Currently, little endoscopic information is available about this region.Design and Setting Endoscopic endonasal cadaveric study.Subjects and Methods Twenty sides in 10 adult cadaver heads were studied endoscopically. The sphenopalatine foramen (SPF) and the adjacent pterygopalatine fossa were exposed. Dissection medial to the vidian canal demonstrated a tunnel that runs posteromedially in the sphenoid floor. Endoscopic data were documented. Additionally, canal measurements were obtained on 20 sides from coronal CT scans of paranasal sinuses.Results The PC was identifiable in 85% of the sides, although thickness of its bony wall was variable. The endoscopic relationship of the canal and its artery with other landmarks is described. Radiologically, the diameter of the PC averaged 1.7 mm, and the mean distance from the PC to the vidian canal was 3.78 mm.Conclusion The current study provides a novel endoscopic identification of an overlooked canal. The pharyngeal artery can be a source of bleeding during extended endoscopic procedures. The PC itself could be a place for finger-like projections of anatomically related neoplasms.