Endoscopic management of superior and posterior refractory epistaxis by cauterization and ligation
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Abstract:
Introduction; Epistaxis is one of the most common otorhinolaryngologic emergencies, often requires urgent and intensive care. The purpose of this study is to show the effectiveness of the endoscopic cauterization of the sphenopalatine artery and anterior ethmoidal artery in a severe posterior and superior epistaxis.
Materials and Methods; From May 2006 to June 2011, sixteen consecutive patients with posterior and superior epistaxis were treated by (undergone) endoscopic cauterization and ligation of 11 shenoplatine arteries and cauterization of the 5 ethmoidal arteries. The age ranged from 22 to 75 years and they were 10 male and 6 female.
Results: In all patients, their blood film was normal. All patients were discharged on 3rd postoperative day. In every case, no intra or post-operative complications were recorded in particular intracranial or intraorbital sequelae. Thirteen patients evolved without rebleeding after cauterization. In three cases epistaxis started again and they need sphenopalatine artery ligation. All patients have subsequently been followed up on average of 18 months with no further episodes of epistaxis.
Conclusion; The endoscopic cauterization of the sphenopalatine artery and anterior ethmoidal artery in a severe posterior and superior epistaxis patient was proven to be safe and efficient.Keywords:
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A brief review of surgery for severe posterior epistaxis has been outlined. Hundred and forty-five (27.3%) patients were treated by transnasal microsurgery in order to undergo ligation of the branches of the sphenopalatine artery in the nasal cavity. The rate of failure was 6.1%. It seems that by using this kind of operation, we can significantly decrease the morbidity in relation to other methods of controlling the posterior epistaxis.
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Transantral ligation of the internal maxillary artery is the most widely used surgical technique for control of intractable epistaxis. Although this technique is highly efficacious, significant complications may occur, including oroantral fistula, damage to the infraorbital nerve, and recurrent bleeding. An endoscopic transnasal approach for ligation of the terminal branch of the internal maxillary artery, the sphenopalatine artery, provides an alternative to transantral ligation. We have used endoscopic ligation of the sphenopalatine artery to treat 38 patients requiring surgical therapy for epistaxis. These cases were retrospectively reviewed to analyze the efficacy and morbidity of our technique. Five patients (13%) had significant recurrence of their epistaxis, of whom two required further surgical intervention. There were no major complications in this series. There were some minor sequelae including nasal crusting (34%) and paresthesia of the palate and nose (13%). The median hospital stay was 3 days (range 1 to 10). Endoscopic transnasal sphenopalatine artery ligation seems to be a safe and effective technique for management of posterior epistaxis.
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Cauterization
Endoscopic sinus surgery
Sinus (botany)
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Epistaxis is a frequent health problem and the most common cause of emergency in otorhinolaryngology practice. In this report, a case of a 26-year-old patient with intractable epistaxis after endoscopic sinus surgery was presented. The epistaxis began at the fourth postoperative day and was unresponsive to endoscopic cauterization and anterior and posterior nasal packing. On angiographic investigation, a pseudoaneurysm of the sphenopalatine artery was detected and treated with microcatheter embolization. This is the second case of postoperative sphenopalatine pseudoaneurysm as a complication of endoscopic sinus surgery in the literature.
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Pseudoaneurysm
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Endoscopic sinus surgery
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Cauterization
Ligature
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Cauterization
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Epistaxis or nosebleed whith has been a challenging problem for our ENT specially, specially inintractable posteriol epistaxis despite consevative measures. As transnasal endoscopic sinonasal surgery has beena widely accepted technique nowadays. Conventional management options in the form of anterior and posterior packing, arterial ligation of the internal maxillary or the external carotid artery and embolization, are not entirely statisfactory because of morbility, high failure rates and significant complication. Out experience of endoscopic cauterization of sphenopalatine anery for two patients with persistent posterior epistaxis is descripbed, which was rapidly controlled following the prosedure. This technique is simple and effective for persistens posterior epistaxis with low morbidity and complication, and should be one of the treatment options to be considered relatively early in the management of epistaxis of eptions to be considered relatively early in the management of epistxis refractory to anterior and posterior nasal packing.
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Introduction Epistaxis is a common otorhinolaryngology emergency condition. Majority of it is anterior epistaxis which usually improves with conservative management. However, for posterior epistaxis, apart from posterior nasal packing, endoscopic sphenopalatine artery cauterization (ESPAC) is considered an effective measure for its control. Hence, this study was conducted to evaluate the outcome of endoscopic sphenopalatine artery cauterization for posterior epistaxis.
MethodsRetrospective medical chart review of patients who underwent endoscopic sphenopalatine artery cauterization for posterior epistaxis from January to December 2018 at Ganesh Man Singh Memorial Academy of ENT-Head & Neck Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal.
ResultsA total of 31 patients (21 males and 10 females) underwent ESPAC during the one-year period. Twenty-seven of them were unilateral whilst four were bilateral. Four of them rebled, of which two bled within 48 hours and the remaining two after two months. The overall success rate of ESPAC was 87.1% (27/31).
ConclusionEndoscopic sphenopalatine artery cauterization is an effective measure to control posterior epistaxis.
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Thirty-six patients with epistaxis requiring hospitalization evaluated over the previous five years were statistically. Twelve patients could not be controlled by the conventional packing method. Ligation of the ethmoidal arteries was perfomed in 4 cases, selective catheter embolization in 5 cases, and turbinectomy and electro-cauterization in 3 cases. In one patient treated by ligation of the ethmoidal artery, and in four patients treated by selective catheter embolization, control of epistaxis failed. All 4 patients were subsequently treated by turbinectomy and electro-cauterization. Because of its relative simplicity and effectiveness, turbinectomy from the infra turbinal posterior end is proposed as the standard method for treatment of epistaxis. Ligation of the ethmoidal arteries should be used for the treatment of epistaxis originating from the olfactory cleft, and selective catheter embolization for treatment of those cases in which the bleeding points were undetectable.
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Background: Endoscopic ligation of the sphenopalatine artery is a safe, simple and effective procedure in the management of refractory posterior epistaxis.Both modalities (cauterization, clipping) show good efficacy in controlling posterior epistaxis with slight advantage of clipping that it showed less post-operative complications.The Aim of study: This work was to compare the efficacy of endoscopic sphenopalatine artery cauterization versus clipping in the management of intractable posterior epistaxis.Patients and Methods: Forty patients were selected for this prospective study in the period between October 2016 to April 2017 at Otolaryngology Department, Tanta University Hospital complaining of recurrent epistaxis (26 males and 14 females).The patient ages ranges between 18-60 years.We selected patients who didn't have history of sinonasal trauma, tumours or bleeding disorders.Twenty patients of the study had an endoscopic sphenopalatine artery clipping, the other twenty had sphenopalatine artery cauterization.The choice between the two surgical techniques has been randomized and all patients have been operated by the same doctor.Results: Among the first group who had SPA cauterization 5 patients had recurrent epistaxis in the 4 th , 5th, 6th , 8th day and after 1 month respectively thus success rate among this group is 75%.Two patients in the group who had sphenopalatine artery clipping had recurrent epistaxis in the 6 th and 7t h day with success rate 90%.Conclusions: Both modalities (cauterization, clipping) show good efficacy in controlling posterior epistaxis with slight advantage of clipping that it showed less post-operative complications.
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Clipping (morphology)
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