Anterior Nosebleed

Causes and Symptoms

These are due to bursting of blood vessels in the front of the nose (anterior part). It is by far the most commonly seen in young children. There is an area just inside the nostril along the septum (Little’s area) where there is a confluence of four different blood supplies to the nose forming a plexus of veins which are very near the surface.

In addition to this, young children often have a mild infection in the nasal cavity called vestibulitis. Any minimal trauma can therefore set off nosebleeds. This can be made worse by associated conditions such as allergy or a viral infection.

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Hot weather can also precipitate nose bleeds.

bipolar-cauterization

Internal views showing a bleeding point before and after cautery

Treatment

In many instances, application of antibiotic ointments such as Bactroban on a twice-daily basis for two weeks can resolve nosebleeds in a significant proportion of children, however, in those in whom it is persistent, cauterisation of the blood vessels is a successful technique in the outpatient setting using silver nitrate. This is done following application of a local anaesthetic nasal spray. Usually, both sides of the septum are not cauterised at the same time in order to avoid the small risk of septal perforation. It is also often the case that cauterisation needs to occur on at least three separate occasions spaced up by six weeks for the best long term outcome.

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