Background
Epistaxis is a common acute presentation to otolaryngology units. In a significant proportion of cases, effective cautery with silver nitrate can be carried out, reducing the necessity for nasal packing. In some cases, bleeding is too brisk to allow localisation of a bleeding point or effective silver nitrate cautery. We describe a method of reducing nasal blood flow to facilitate more effective nasal cautery.
Technique
The technique involves infiltration of local anaesthetic and adrenaline into the region of the greater palatine foramen to induce vasospasm in the greater palatine artery. A 2ml volume of 2% lignocaine/1:80,000 adrenaline is drawn up into a 2ml syringe and a 25G needle attached. The needle shaft is then bent to 45° at midpoint, bringing the bevel towards the syringe.
The grater palatine foramen is located at the posterior aspect of the hard palate, approximately 1cm medial to the third upper molar on the side of the epistaxis (Fig 1). A finger or cotton wool pledget can be used to palpate it. The needle is gently inserted and aspiration attempted to prevent intra-arterial injection and its potential complications. If no blood is aspirated, 1–2ml of solution can be infiltrated (Fig 2). Onset of vasospasm is fairly rapid, allowing bleeding point localisation and cautery.
Figure 1.
Location of the greater palatine foramen
Figure 2.
Infiltration point
Discussion
This is a simple, safe technique using inexpensive materials and drugs. It rapidly reduces blood flow to the nose, especially in its inferior region. This assists in localisation of bleeding points and facilitates easier cautery.