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Background and Objectives: This paper presents an overview on nasal packing materials which are available in Germany. The current literature is analyzed whether there are robust criteria regarding use nasal packing after sinonasal surgery, whether there are fundamental and proven advantages or disadvantages of products, and what this means in clinical practice., Materials and Methods: Selective literature analysis using the PubMed database (key words "nasal packing", "nasal tamponade", "nasal surgery", "sinonasal surgery", or "sinus surgery"), corresponding text books and resulting secondary literature., Results and Conclusions: Because of systematic methodological shortcomings, the literature does not help in the decision-making about which nasal packing should be used after which kind of sinonasal surgery. In fact, individual approaches for the many different clinical scenarios are recommended. In principle, nasal packing aims in hemostasis, should promote wound healing, and should not result in secondary morbidity. Nasal packing materials should be smooth (non-absorbable materials), inert (absorbable materials), and should not exert excessive pressure. Using non-absorbable packing entails the risk of potentially lethal aspiration and ingestion. For safety reasons inpatient control is recommended as long as this packing is in situ. With other, uncritical packing materials and in patients with special conditions, outpatient control could be justified., (© 2023. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Unlabelled: Treatment of Recurrent Epistaxis by Artery Ligation: Up to Date or Old Fashioned?, Background: Despite the ongoing development in the field of endoscopic treatment techniques, recurrent epistaxis remains a challenge for otolaryngologists. The aim of the present study was to compare our own results of various interventions for the treatment of recurrent epistaxis., Materials and Methods: From 2007 to 2013 we performed surgical treatment of recurrent epistaxis under general anaesthesia in 148 cases. While the majority of causes were idiopathic (n=98), epistaxis also occurred postoperatively (n=30), post-traumatically (n=7) or as a result of M. Osler (n=12). In 141/148 cases the treatment was performed by mono- or bipolar coagulation in the area of the bleeding source - this required an ethmoidectomy in 17 cases. In 19 cases the intervention was combined with a septoplasty. In 4 patients with recurrent bleeding of unknown origin, where electrocoagulation under general anaesthesia failed, we performed a clipping of the ethmoid- and/or the maxillary arteries in the pterygopalatine fossa. Following this intervention no further bleeding episodes occured. In further 3 patients, neuroradiological embolization was successfully performed., Conclusion: If conservative measures fail in the treatment of epistaxis, surgical treatment by electrocoagulation of the bleeding site under general anaesthesia is an effective intervention in 95% of cases. However for the remaining 5% where these measures have been proven to be ineffective, clipping of the ipsilateral anterior and posterior ethmoid- and/or the maxillar artery provides a treatment option being equally efficient as neuroradiological interventions., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: According to recent statistics more and more elderly patients are hospitalized due to epistaxis and need anticoagulation. Aim of the present study was to investigate if it was more complex to treat anticoagulated patients than non-anticoagulated patients, if these patients needed a longer hospital stay and to characterize the study population in terms of the various applied therapeutic methods., Methods: Retrospective study, collecting clinical data of all in-patients treated between 1.1.2007 to 1.8.2011 at an ENT-Department of an University Clinic due to epistaxis., Results: Of 656 patients 265 were not anticoagulated, 391 were anticoagulated. The mean patients' age increased statistically significant. Patients without anticoagulation were significantly younger than patients with anticoagulation. The duration of the hospitalization differed significantly between the groups, with the longest for patients treated with warfarin (5.4 days). 71 patients underwent surgical treatment of epistaxis (cautery of the sphenopalatine artery or anterior ethmoid artery)., Conclusion: During the study period an increasing number of more elderly patients needed hospitalization due to epistaxis. The duration of hospitalization differed significantly between the groups, with longer stays for the anticoagulated patients. Currently, treatment of epistaxis patients however is reimbursed independently of the presence of comorbidities or anticoagulation therapy. For the further development of the German DRG System a new split of the epistaxis DRG should be considered., (© Georg Thieme Verlag KG Stuttgart · New York.)

Epistaxis or nosebleed is one of the most frequent emergencies in otorhinolaryngology. It is clearly an important condition--not only to the ear-nose-throat (ENT)-specialist but also to any general practitioner. This review looks at the aetiology, associated clinical considerations and evolution of its management. Intractable epistaxis requires a broad armamentarium of different diagnostic and therapeutic options.

The following report reviews the rare case of a peripheral giant cell reparative granuloma of the nose. Complete surgical removal of the tumor by midfacial degloving took place after histologic examination. Taking current literature into consideration, the clinical and histopathologic features, diagnostic procedures, including differential diagnostic considerations, and adequate therapy are discussed.

Background: Epistaxis is one of the most common otolaryngological emergencies. In cases of bleeding from the anterior or the lower posterior part of the nose, epistaxis could usually be treated with cauterization and anterior or posterior nasal packing. More invasive methods of treatment are the endonasal coagulation of the sphenopalatine artery and the transantral ligation of the maxillary artery. Bleeding from the upper posterior part of the nose usually originates from the anterior and the posterior ethmoidal artery. In most cases a specific styptic treatment in the upper posterior part of the nose is not possible because of a diffuse bleeding from the ethmoidal arteries into the ethmoidal sinus and the lateral wall of the nasal cavity. In this study the endoscopic ethmoidectomy is presented as the therapy of epistaxis from the ethmoidal arteries., Patients and Results: In the retrospective study the charts of twenty patients with intractable epistaxis from the upper posterior part of the nasal cavity were reviewed. In all cases the bleeding could not be controlled with anterior and posterior nasal packing. In seventeen patients the bleeding could be controlled with a unilateral or bilateral endoscopic ethmoidectomy (average follow-up: 36.5 months). Three patients who complained of a coagulopathy and an arterial hypertonia developed diffuse recurrent bleeding from multiple sources. In one case the recurrent bleeding was controlled by an unilateral transantral ligation of the maxillary artery and a bilateral revision of the ethmoidectomy. In two patients the recurrent bleeding was treated with bilateral posterior nasal packing., Conclusion: The endoscopic ethmoidectomy is an efficient therapy of intractable epistaxis from the ethmoidal arteries if systemic coagulopathy and arterial hypertonia are excluded. The ethmoidectomy can be performed by any head and neck surgeon who is familiar with endonasal surgery.

Patients with hereditary hemorrhagic telangiectasia (M. Osler-Rendu-Weber disease) often suffer from recurrent epistaxis that poses considerable therapeutic problems. Dermoplasty, electrocoagulation, laser coagulation, iridium brachytherapy and systemic administration of estrogens have been proposed for treatment. Until recently argon plasma coagulation (APC) was not used in ENT surgery, but theoretical considerations render APC a promising therapeutic method for controlling nasal bleeding. Coagulation of tissue is limited to 1-2 mm of penetration and therefore risk of damage to adjacent tissue is low. Effects are best in tissues with high electric conductivity, especially for coagulating bleeding lesions and blood vessels. We have now treated four patients with telangiectasias in the nasal mucosa who had long histories of treatment for epistaxis. The patients were satisfied with the postoperative results and the frequency and intensity of bleeding were significantly reduced. Initial clinical experiences show that APC is a useful alternative for the treatment of bleeding telangiectasias in the nasal mucosa.

Rendu-Osler-Weber disease is an autosomally dominant inherited disease which affects the connective tissue of blood vessels. The major symptom is recurrent epistaxis for which still exists no generally recommended treatment. Treatment modalities discussed in the literature include bilateral closure of the nostrils, brachytherapy, vessel embolization, hormone therapy, dermoplasties, as well as different kinds of laser therapies. Advantages and disadvantages of single treatment modalities are discussed. Dermoplasty and laser therapy seem to be the most suitable treatment procedures currently available for recurrent epistaxis in affected patients. Treatment carried out with the argon, KTP or ND:YAG laser has proven to be suitable as initial therapy. In most cases the additional use of long-term applications of a soft nasal ointment allows a lasting successful treatment. Our experiences show that dermoplasty should be reserved for cases with continued bleeding despite laser treatment but only rarely offers a long-term cure in the sense of a total recovery from epistaxis.

Background: Until a few years ago the surgical method of choice in treating uncontrollable nosebleeds from the posterior part of the nose was the transantral ligation of the maxillary artery as described by Seiffert (Caldwell-Luc approach). We introduce a surgical method to expose and coagulate the sphenopalatine artery through an endonasal approach., Method: The middle meatus of the nose is exposed with a self supporting nasal speculum under the microscope (focus: 300 mm) and the maxillary sinus is opened through the posterior fontanelle. The medial wall of the maxillary sinus is removed from this opening to its end. Three to five millimeters posterior to this site, the foramen sphenopalatinum is exposed. The osseous lateral margin of the foramen is resected with the drill and the fossa pterygopalatina is thereby opened from the nose. The sphenopalatine artery can be exposed all the way to its origin from the maxillary artery and then coagulated., Results: Thirty-one patients with severe epistaxis have been operated by this method since October 1993. No postoperative complications were observed in any cases. Thirty patients have had no further nosebleed since than (average follow-up 22.9 months). In one case of a patient with renal insufficiency a nose bleed occurred 15 day postoperatively following dialysis. It was controlled by ligation of the anterior ethmoid artery and of the peripheral branches of the external carotid artery., Conclusion: The endonasal coagulation of the sphenopalatine artery is the safest method to control bleeding from the posterior parts of the nose. It can be performed by anyone who is familiar with endonasal surgery. The disadvantages of the transanteral ligation of the maxillary artery as described by Seiffert (Caldwell-Luc approach, ligation not sufficiently peripheral) are avoided. The only competing method would be the embolization of the sphenopalatine artery which can not be applied in every hospital and which has a higher complication and failure rate. Since October 1993 when this method was introduced no additional bellocq tamponade was required in epistaxis.

Of all possible types of epistaxis, 80%-95% originate in the anterior nasal septum. Despite various possibilities for treatment the therapy often remains unsatisfactory. In cases of recurring epistaxis, a prominent vessel very often exists leading from the bottom of the nose of the septum. In these cases, we make an incision in the angle between the bottom of the nose to the septum. In these cases, we make an incision in the angle between the bottom and the septum. We have been using this method successfully for a number of years and its has the particular advantage that there is no risk of damaging the cartilage.

Severe and recurrent epistaxis in cases of Rendu-Osler-Weber's disease can be treated best by septal dermoplasty and intranasal skin grafting beyond the septum to include the upper lateral cartilage and interior turbinate as well as the floor of the anterior part of the nose. Combined with a large defect of the nasal septum the dermoplasty alone with the lining of the anterior part of the nose with split-thickness skin grafts is not without problems because of the excessive dryness and the severe and in part malodorous crusting of the nasal cavity. The necessary removal of the crustings can effect recurrent epistaxis. In this case, the reconstruction of the large septal defect with a frontotemporal flap is recommended. The temporal part of this pedicled forehead flap is taken from a region, which is only slightly affected by the teleangiectasias. Four weeks after the implantation of the frontotemporal flap into the septal defect the pedicle of the flap can be transected and removed. The functional result of this reconstruction of the nasal septum combined with the dermoplasty is satisfying.

A unit consisting of an argon-ion-laser, a flexible beam guide system and a probe for endonasal lasersurgical applications is described. The instrument has been used successfully for several years. Endonasal lasersurgical techniques are described. Pathological tissue can be coagulated or carbonised in the form of a point or a line. In particular, lasersurgical techniques are described for surgery of the lower turbinates, for coagulation of Little's area in case of chronical nose bleeding, for coagulation or carbonisation of teleangiectasia in case of Morbus Rendu-Weber-Osler, for production of a nasoantral window, and for other applications.

For the past 25 years we have been able to control severe epistaxis in all patients by an intranasal procedure. If the source of bleeding in patients with epistaxis from the upper part of the nose cannot be seen during the acute phase, a combined anterior-posterior nasal pack is inserted and left in place for three days. Should bleeding persist or recur after removal of the packing we resect the superior nasal septum to expose the bleeding point in the anterior area of the cribriform plate. Cauterization at this site is not safe because of the risk of CSF rhinorrhea, and it is not always successful, as the main blood supply to the ethmoidal arteries stems from the internal carotid artery. Cauterization of the anterior or posterior ethmoidal arteries within the bony canal of the ethmoidal sinus (after partial ethmoidectomy) is always successful. Ligation or embolization of the carotid arteries is indicated only for tumour patients. Intranasal ethmoidal microsurgery requires much practice and preliminary experience on at least 50 cadavers. In 25 years with an annual load of about 180 ethmoidal sinus surgery cases we have never had serious complications such as cerebrospinal fluid rhinorrhea or persisting optical disturbances in more than 4,000 operations. During 1984 at the Krupp Hospital we used the intranasal microsurgical approach for all patients with septal, ethmoidal sinus and lacrimal duct pathology, for 98% of cases requiring maxillary sinus procedures and for 82% of patients with frontal sinus problems.(ABSTRACT TRUNCATED AT 250 WORDS)

For more than ten years, circumscribed dermoplasty has been successfully used in the treatment of persistent bleeding from the anterior nasal septum. In patients treated, neither septal perforation nor crust formation have been observed.

Between 1978 and 1980 in the ENT clinics of Mannheim 19 patients with severe epistaxis have been treated surgically. Nearly always epistaxis was due to hypertonus or arteriosclerosis. Before ligation of maxillary or ethmoid arteries Bellocq's nasal packing was used. Ligation was always successful. After one year in three cases we observed a recidive of epistaxis, not due to bad surgical treatment but rich anastomoses of the maxillary artery. It is strange, that artery ligation is recommended, when posterior nasal packing fails, although its complications are more severe and frequent than those of chirurgical treatment including the anesthesiological risk. Ligation in severe epistaxis is effective and of low risk. It is an alternative to posterior nasal packing.

Head and neck surgery is accompanied by more or less heavy tendency to bleed. Spontaneous bleeding will occur, because of general and local peculiarities depending on the vascularisation of this region. The general part of the paper deals with normal haemostasis and the diagnosis of haemorrhagic diathesis. This part also shows simple surgical measures in order to stop bleeding. The special section of the paper explains bleeding problems by case history. Here mainly complications are shown exceedingly imporant to the ENT Doctor, because of their more common frequency i.e. nose-bleeding, adenotonsillextomy as well as alarming haemorrhage from great vessels of the neck (arrosion bleeding of the carotid artery, lesion due to accidents and following necksurgery).