title: Posterior epistaxis: identification of common bleeding sites.
abstract: OBJECTIVE
  The objective of this study was to determine common bleeding sites in the nasal cavity of patients with posterior epistaxis and thus review our management protocol.
  
  
  METHODS
  A prospective study was carried out from 1989 to November 2003 in the otolaryngology-head and neck surgery department of a tertiary referral center. This study included patients who presented with posterior epistaxis uncontrolled with standard nasal packing and with no identifiable bleeding point on examination under local anesthesia.
  
  
  METHODS
  All patients underwent a formal examination under general anesthesia by the senior author of this article. Findings at examination were documented along with subsequent management and its outcome.
  
  
  RESULTS
  Forty-three patients were included in this study. Bleeding points were identified in 36 cases. Seven patients had septal bleeding points (20%). The rest were located on the lateral nasal wall (81%). Of these, 4 were on the lateral wall of inferior meatus, 7 on the lateral surface of inferior turbinate, 8 on the lateral wall of middle meatus, and 10 on the lateral surface of middle turbinate. All were located posteriorly.
  
  
  CONCLUSIONS
  We recommend examination under general anesthesia when conservative measures fail to control bleeding, concentrating on the posterior aspect of the lateral nasal wall. In addition, the lateral aspect of the middle and inferior turbinates may contain a groove within which bleeding points may be concealed. The lateral position of most bleeding sites indicates that use of nasal packing can only attempt to indirectly tamponade blood flow and is rarely justified bilaterally. Electrothermocautery can achieve excellent results with minimal complications. Failure to identify a bleeding point, after thorough examination under general anesthesia, does not require further intervention unless complicated by further bleeding.
authors.affiliation: Department of Otolaryngology, University Hospital Galway, Galway, Ireland.
authors.forename: M A
authors.initials: MA
authors.lastname: Thornton
authors.forename: B N
authors.initials: BN
authors.lastname: Mahesh
authors.forename: J
authors.initials: J
authors.lastname: Lang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D004564:Electrocoagulation; D004844:Epistaxis / Q000175:diagnosis* / Q000601:surgery / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009296:Nasal Cavity / Q000473:pathology*; D009300:Nasal Septum / Q000473:pathology; D011446:Prospective Studies; D012008:Recurrence; D013630:Tampons, Surgical; D016896:Treatment Outcome; D014420:Turbinates / Q000473:pathology