In absence of any clear bleeding points seen on the septum, it is generally presumed that the epistaxis is posterior, especially when simple cauterisation of the septum does not help and may progress to sphenopalatine ligation. In this publication, the author has demonstrated that in over 92% of cases where points of bleeding could not be demonstrated in the anterior part of the nose and posterior epistaxis was presumed, there were in fact sources of bleeding in the anterior part of the nose and these were missed. A detailed examination protocol, using 0, 30, 45 and 70-degree endoscopes with help of local anaesthesia has been described. The bleeding points identified were in the lateral wall of the inferior meatus, anterosuperior wall of the nasal cavity, roof of the anterior nasal cavity, osteum pharyngeal tubae and anterior nasal base. Bleeding sites hidden between the alae of the nose and anterior part of the cartilaginous septum were possible to detect with the thorough examination protocol described. All these bleeding points were treatable in an office setting with microwave ablation. A description of the morphology such as telangiectasia, ulceration and likewise is also provided.

Does epistaxis with an unknown bleeding site originate from the posterior part of the nasal cavity?
Lou ZC.
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Madhup K Chaurasia

Mid and South Essex NHS Foundation Trust, UK.

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