Prominent vessels of nasal septum over left Little's area
(circle) which can potentially cause epistaxis.
A florid and established vascular ectasia of left Little's area with bleeding occuring almost everyday for a week before consultation. Bipolar cautery vessels ablation was then performed under general anaesthesia.
Anterior nasal endoscopy without using nasal speculum. Note vibrissae
coming into view if untrimmed which may potentially smear the endoscope tip.
Aural speculum being used to protect surrounding structures
prior to cauterization of abnormal vessel seen in view.
Abnormal septal capillaries of Little's area as seen under microscope view.
Right Little's area abnormal vessels made prominent after topical co-phenylcaine spray, thus making targeted cauterization easier and more accurate.
Watch video of abnormal blood vessels at Little's area @ YouTube
Watch another video of blood vessels which can cause nose bleeds @ YouTube
The commonest site of epistaxis is from Little's area which is the confluent of capillaries of the Kiesselbach's plexus (ellipse). First aid measures include bilateral press of the alar cartilage (soft part of the nose) firmly for a few minutes (for tamponade effect) while breathing through the mouth, and sucking small ice cube in the mouth (for vasoconstrictive effect).
Spontaneous epistaxis from left Little's area in a Dengue Fever patient with platelet count of 11 x 109/L.
Retrograde haemotympanum in a patient who had violent coughs following gag reflex and retching during a severe epistaxis from left Little's area.
Endoscopic image pre-removal.
(X - granulation, V - vestibule, IT - inferior turbinate, S - nasal septum)
Endoscopic view post-removal.
(V - vestibule, IT - inferior turbinate, S - nasal septum)
Histologically-confirmed early septal haemangioma (ellipse) involving right Little's are just beyond the mucocutaneous junction (dashed line). (S - superior, I - inferior, L - Little's area, IT - inferior turbinate, arrow - septal spur)
Immediate post-excision image. The perichondrium was well-preserved with re-epithelialization expected to occur readily.