Thank you for your query.
1. Did the nose bleed (epistaxis
) stop after nasal packing or on it's own? What was the quantity of teh blood loss? What is the patient's age? Was a hemogram and coagulation profile done?
2. This seems to be an Oro-Antral fistula as there is a history of a portion of the upper gum breaking off during wisdom tooth extraction
and stitches being required four months ago.
3. The maxillary nasal sinus is separated from the upper teeth by a thin plate of bone which may even be missing in some persons.
4. Sometimes, blood vessels torn during bone fractures cannot retract and close due to bone fragments and hence the bleeding is severe.
5. You may share the CT Scan images for a detailed opinion.
6. If the bleeding has stopped, there is no further treatment. If it happens again a nasal endoscopic examination will show the bleeding area. The maxillary sinus may have to be opened to see the exact site. Ice fomentation over the gum and sinus (cheek) may be used for sudden nasal bleeding
7. The blood pressure, hyperthyroidism
should be controlled. A tablet such as ethamsylate (Sylate) or tanexamic acid (Pause) will help. Is the patient on any blood thinning or anti-platelet medications?
8. The feeling of a cold and vertigo
after 2-3 days of epistaxis may be a sign of infection of the blood clots
in the maxillary sinus. AN antibiotic may have to be started.