Epistaxi (nosebleed) 耳鼻咽喉科学课件.ppt

Mucocele and Cyst Cyst of nasal vestibule Vestibule, maxillary dental alveoli, unilateral round/oval cyst Diagnosis: palpation, punction X-ray Treatment: resection of cyst Adenoid cystic carcinoma 4% more in ethmoid sinus Sarcoma: 10-20% malignant tumors in ORL More in nasal cavity and maxillary sinus. Malignant lymphoma60%； — Malignant epithelia tumor. Carcinoma of nasal vestibule and Septum Carcinoma of the paranasal Sinus Melanoma Esthesioneuroblastoma — Malignant nonepithelial tumor. Rhabdomyosarcoma. Hemangiopericytoma lymphoma Extramedullary plasmacytoma. Symptoms Signs： Nasal Cavity: — nasal obstruction. — epistaxis. — pain. — numbness of cheek. Paranasal sinus: — purulent drainage with blood — nasal obstruction (unilateral, progressive) — extrusion of cheek — extrusion of hard palate — Ophthalmologic symptoms: proptosis, epiphora, visual acuity decrease, orbital apex syndrome — cranial involvement * Epistaxis (nosebleed) Etiology： 1、 Local causes： 1）Trauma：mucosa laceration blood vessel injury 2）Inflammation of nose and sinus 3）Diseases of septum 4）Tumor：nasal cavity tumor sinus tumor angiofibroma of nasopharynx 2、 General factors Systematic disease—— Ascension of arterial pressure and venous pressure， Dysfunction of coagulation, Change of blood vessel tension. 1） Acute epidemical diseases 2） Cardiovascular diseases 3） Hemological diseases 4） Nutrition defect：VitC、K、P or calcium 5） Liver, kidney diseases and rheumatic fever 6） Poison ：phosphorus, mercury, arsenic, benzene 7） Osler’s disease hemorrhagic familial telangiectasia 8） Endocrinic imbalance Treatment： 1、 Fundamental treatment Emergency: sedation estimate the bleeding amount keep proper posture No blood ingest 2、 Hemostatic methods 1）Identify the bleeding site pinch the nostrils 2）Cautery techniques chemical electrical laser radiofrequency microwav