Nose bleeding or epitaxis is a common condition in which the bleeding occurs from nostrils, nasopharynx or nasal cavity. The bleeding in most cases is confined to one nostril and occurs due to the rupture of blood vessels associated with the septum. It usually subsides by itself and is rarely life threatening; but there can be some cases in which bleeding may persist. These cases require immediate medical attention as they may be warning signs of unidentified cancers.
Nose Bleed From Injury Of Septum Or Turbinate: An overview
Nose is a cartilaginous structure present on the face that allow passage of air in and outside the body through the process of breathing. The internal structure of the nose is made up of nostrils, which are separated by cartilaginous septum. The vascular composition of the nasal septum is extensive, as a result there exists a rich supply of blood around it. Thus, whenever the nasal septum gets injured, it may result in nose bleeding or epitaxis.
Nose bleed can further be categorized on the basis of the location of septal injury, which can be either anterior or posterior. The anterior epitaxis or nose bleed involves injury to the Kiesselbach's plexus, where a large mass of blood vessels is present in the front part of the septum. These blood vessels get injured very easily. The posterior epitaxis or nose bleed, on the other hand, occurs when the Woodruff's plexus blood vessels that are present at the back of the nose, get injured. The Woodruff's plexus are located over the middle turbinate at the posterior end of the nose. It results in bleeding from upper part of the nose, through the throat to the mouth. Out of the two, the anterior nose bleed is more common due to the vulnerability of Kiesselbach's plexus blood vessels towards injuries.
Characteristics of Nose Bleed from Injury of Septum or Turbinate
The common characteristics of nose bleed from injury of septum are:
- Bleeding from nostrils. Usually, from a single nostril but can occur from both the nostrils.
- Sensation of presence of fluid at the back of the nose.
- Increased frequency of swallow in children.
- Persistent sense of congestion within the nose.
Prognosis of Nose Bleed from Injury of Septum or Turbinate
Largely, the outlook for epitaxis is good, but a variable extent of recovery can be expected amongst different individuals. The condition requires immediate treatment and is rarely fatal, except in older patients. When appropriate treatment is administered in time, the chances of rebleeding and other complications are reduced to nil.
Causes of Nose Bleed from Septum or Turbinate
The basic reason for nose bleed from septum or turbinate is injury to these structures. Other factors that can cause nose bleed are:
- Accident or a strong blow to the nose.
- Repeated picking of nose.
- Frequent application of nasal sprays.
- Nasal fractures.
- Deviated Septum.
- Surgical treatments like orbital surgery, skull base surgery and endoscopic sinus surgery.
Complications of Nose Bleed from Injury to Septum or Turbinate
The complications usually appear after surgical procedures related to septum or turbinate injuries. Some of these complications are:
- Numbing sensation within the structures adjoining the nose.
- Perforations in the nasal septum.
- Modified sense of smell or taste or both.
- Onset of sinus problems.
- Nasal congestion and obstruction.
- Severe nasal bleeding as well as drainage.
- Rare instances of infection or leaking of brain fluid.
Diagnosis of Nose Bleed from Injury to Septum or Turbinate
The diagnosis of the condition is based on the visible nasal bleeding and physical examination of the injured nose. However, the severity of the condition can be studied better through X-ray analysis and nasal endoscopy. The X-ray images provide an insight about the injury, whether the head is also related in the injury or just localized to the nose. On the other hand, the nasal endoscopy involves analysis of the blood vessels and adjoining areas through insertion of minute camera up inside the nose.
Treatment of Nose Bleed from Injury to Septum or Turbinate
The treatment for injured septum or turbinate can be divided into two categories, which are:
First line of Treatment for Nose Bleed from Injury to Septum or Turbinate: It includes immediate treatments that can be provided to patient, in case of ruptured blood vessels and no nasal fractures.
- Pinching of Nose: It can be done immediately, post the injury. The procedure follows keeping the patient upright and then pinching of nostrils using thumb and forefinger, for at least 5 to 10 minutes. Then, checking if the bleeding has stopped, in case the bleeding has not stopped then, the above steps should be repeated for another 5 to 10 minutes. Mostly, the bleeding stops by then.
- Cold Compression: It can be done by placing ice packs on the bridge of the nose. This helps in clotting of blood and reduce the nasal bleeding.
- Nosebleed QR: Another first line treatment, is Nosebleed QR or Quick Relief. This is a polymer that absorbs the blood from the nose and aids in blood clotting thereby reducing the bleeding from the nose.
- Herbal Medicines: Herbal preparations of achillea, vitamin E oils, geranium and trillium help in reducing the nasal bleeding.
Surgical Treatment for Injury to Septum or Turbinate leading to Nose Bleed: These treatments are mostly followed in case of nasal fractures.
- Turbinectomy: This surgery involves microdebridement or removal of extra tissues from the turbinate, using an endoscope.
- Turbinoplasty: This procedure involves fixing the position of turbinate by placing a device within the nose. It may also involve minor microdebridement.
- Laser Ablation: This technique uses laser light through an endoscope to shrink the turbinate tissues.
Prevention of Nose Bleed form Injury of Septum or Turbinate
The main precautions that need to be followed to prevent nose bleed is to avoid any strong blow to the nose. One must also prevent dryness of nasal passage, as this aids in easy rupture of nasal blood vessels as well as toughening of the septal areas and blood vessels.
- Using ice packs right after a blow or accident to prevent nose bleed from septal or turbinate injury.
- Preventing Dryness with Petroleum to Prevent Nose Bleed from Injury of Septum or Turbinate: To prevent the dryness of nose, a thin layer of petroleum jelly or a similar ointment can be applied inside the nostrils.
- Ointments: Estrogen creams help greatly in revitalizing nasal tissues and toughening the blood vessels.
- Bioflavanoids to Strengthen Septum to Prevent Massive Injury and Nose Bleed: These are supplements which should be taken twice a day to strengthen the septal blood vessels.
Septal or turbinate injuries can easily result into nasal bleeding. In most cases, the nose bleeding can be controlled through non-surgical treatments like home remedies and nose pinching. In severe cases of nasal fractures, surgery may be required to fix the position of the nose and remove the debris that occur due to fractured septum.