Although rhinorrhea can occur in any part of the nasal cavity, it is closely related to the distribution of blood vessels. Clinically, nasal bleeding can be divided into three easy bleeding areas: upper nasal bleeding, anterior nasal bleeding and posterior nasal bleeding according to the site of occurrence.
I. Upper nasal bleeding area
The blood supply of upper nasal bleeding comes from the branches of the anterior or posterior sieve artery, which belongs to the internal carotid artery system.
Posterior nasal bleeding area
The blood supply comes from the pterygopalatine artery or its branches, which belongs to the external carotid artery system.
Anterior nasal bleeding area
The anterior nasal hemorrhage area is located in the anterior and inferior part of the nasal septum, which is the anastomosing network of the anterior septal artery, the pterygopalatine artery, the great palatine artery and the last finger branch of the superior labial artery. This zone is called the Littoral (Little) zone. In front of this zone, there is a venous anastomotic network behind the nasal tubercle, called Keisselbach’s Plexus. This area is covered by a thin layer of membrane and lacks submembranous tissue. Sometimes the bleeding point is close to the junction of the skin and membrane in the nasal vestibule, so called “nasal septal hemorrhagic polyp”, which also occurs here.
I. Local causes
(A) Idiopathic
(B) traumatic
Due to local mechanical injury, such as nose picking, nose lifting, nasal feeding, nasal foreign body, etc. Rupture of internal carotid artery due to skull base fracture (nasal bleeding by borrowing channel). Surgical trauma, such as maxillary sinus prick lavage, nasal biopsy, turbinate surgery, etc.
(C) Inflammatory
Acute rhinitis, acute sinusitis, dry rhinitis, atrophic rhinitis, nasal septum level membrane erosion, stimulation of harmful chemical gases and atopic infections, such as diphtheria, etc. Hemorrhagic necrotizing nasal polyp is a hemorrhagic disease resembling a malignant tumor. It can be confirmed by pathological examination.
(iv) Nasal septal disease
Nasal septal deviation, perforation, etc.
(E) Nasal sinus tumor
1.Benign tumor Nasal septum capillary hemangioma, nasal cavity sinus hemangioma.
2.Malignant tumor Malignant tumor of nasal cavity and sinus, malignant granuloma, etc.
(6) Nasopharyngeal tumor
Nasopharyngeal fibrovascular tumor, nasopharyngeal carcinoma, etc.
II. Systemic causes
(I) Blood diseases
Leukemia, aplastic anemia, etc.
(ii) Hypertension, arteriosclerosis.
(C) Increased venous pressure
Emphysema, pulmonary heart disease.
(IV) Vitamin E, K, B2, P deficiency.
(V) Poisoning
Mercury, phosphorus, arsenic, benzene poisoning.
(VI) Other
Acute infectious diseases, endocrine disorders (ectopic menstruation), active rheumatic fever, uremia, sepsis, etc.