A 6-year-old boy is brought to the emergency department by his parents due to persistent nasal bleeding. The boy picks his nose frequently and has had several nosebleeds in the past, all of which stopped spontaneously after pinching the nose. The parents say that they have been pinching the nasal alae for over 30 minutes while the boy leans forward. Family history is negative for bleeding disorders. The patient takes no medications and has no allergies. Examination shows continuous blood trickle from his right nostril. Silver nitrate cautery is performed and the bleeding stops. Cautery was most likely applied to which of the following locations in this patient's nasal cavity?

Question

A 6-year-old boy is brought to the emergency department by his parents due to persistent nasal bleeding.  The boy picks his nose frequently and has had several nosebleeds in the past, all of which stopped spontaneously after pinching the nose.  The parents say that they have been pinching the nasal alae for over 30 minutes while the boy leans forward.  Family history is negative for bleeding disorders.  The patient takes no medications and has no allergies.  Examination shows continuous blood trickle from his right nostril.  Silver nitrate cautery is performed and the bleeding stops.  Cautery was most likely applied to which of the following locations in this patient's nasal cavity?

Quizplus · Accepted Answer

11ec160b_356a_b710_9249_fd2787e67193_MD0001_00 The nasal mucosa is highly vascular and easily irritated by trauma (eg, nose-picking), mucosal dryness, foreign body insertion, and rhinitis (eg, allergy, infection). Epistaxis is very common in children and may be classified as anterior or posterior, depending on the bleeding source. Anterior nosebleeds are by far the most common, and the vast majority occur within the vascular watershed area of the nasal septum (anteroinferior part of the nasal septal mucosa) known as Kiesselbach plexus. Anastomosis of the following vessels occurs in this region: Management is directed at stopping the bleeding from Kiesselbach plexus, preferably by direct compression of the nasal alae. Cautery (eg, silver nitrate) of the area surrounding the bleeding site may be necessary for persistent bleeding. (Choices A and B) The lateral nasal wall contains the superior, middle, and inferior turbinates (also known as conchae). These 3 bony projections are covered with mucous membrane; they warm, humidify, and filter inspired air and expand and contract in response to environmental changes (eg, temperature, humidity, allergens). The turbinates form corresponding meatuses that serve as drainage pathways. The superior meatus provides drainage for the sphenoidal and posterior ethmoidal sinuses. The middle meatus drains the frontal, maxillary, and anterior ethmoidal sinuses and is the most common site of nasal polyps. The inferior meatus drains the nasolacrimal duct. (Choices D and E) Branches of the sphenopalatine artery supply the posterolateral wall and posterior choanae. These posterolateral branches are the most likely source of posterior nosebleeds. Posterior epistaxis is usually severe and cannot be treated with cautery. Educational objective: Epistaxis is commonly caused by irritation of the highly vascular mucosa at the anterior nasal septum. The anterior nasal septum contains the Kiesselbach plexus. The anterior ethmoidal, sphenopalatine, and superior labial arteries anastomose in this region. __________ References: Fifteen-minute consultation: investigation and management of childhood epistaxis. (http://www.ncbi.nlm.nih.gov/pubmed/25035314) Interventions for recurrent idiopathic epistaxis (nosebleeds) in children. (http://www.ncbi.nlm.nih.gov/pubmed/22972071)

A 6-Year-Old Boy Is Brought to the Emergency Department by His