665 results on '"Epistaxis surgery"'
Search Results
2. Preservation or removal of the lateral nasal wall in endoscopic management of maxillary sinus neoplasia: A comparison of approach related morbidity.
- Author
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Kondo M, Seresirikachorn K, Gomes JPMC, Wong E, Png LH, Kalish L, Sacks R, and Harvey RJ
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- Humans, Male, Female, Retrospective Studies, Middle Aged, Aged, Postoperative Complications epidemiology, Postoperative Complications etiology, Adult, Treatment Outcome, Epistaxis etiology, Epistaxis surgery, Cohort Studies, Paresthesia etiology, Endoscopy methods, Maxillary Sinus Neoplasms surgery, Maxillary Sinus surgery
- Abstract
Background: The endoscopic modified medial maxillectomy (MMM) and prelacrimal approach (PLA) are two routinely performed endoscopic approaches to the maxillary sinus when access via a middle meatal antrostomy is insufficient. However, there is no data in the literature that has compared outcomes and complication profile between the two procedures to determine which approach is superior., Objective: To compare the approach related morbidity of PLA and MMM., Methods: A retrospective cohort study of all consecutive adult patients undergoing either MMM or PLA from 2009 to 2023 were identified. The primary outcome was development of epistaxis, paraesthesia, lacrimal injury, iatrogenic sinus dysfunction within a minimum of 3 months post-operative follow up., Results: 39 patients (44 sides) underwent PLA and 96 (96 sides) underwent MMM. There were no statistically significant differences between the rates of paraesthesia (9.1 % vs 14.6 %, p = 0.367) or prolonged paraesthesia (2.3 % vs 5.2 %, p = 0.426), iatrogenic maxillary sinus dysfunction (2.3 % vs 5.2 %, p = 0.426) or adhesions requiring removal (4.5 % vs 4.2 %, p = 0.918). No cases of epiphora or nasal cavity stenosis occurred in either arm in our study., Conclusions: According to our data, the endoscopic modified medial maxillectomy and prelacrimal approach are both equally safe approaches with their own benefits to access., Competing Interests: Declaration of competing interest Richard J Harvey is a consultant/advisory board with Medtronic, Novartis, Glaxo-Smith-Kline and Meda pharmaceuticals. He has been on the speakers' bureau for Glaxo-Smith-Kline, Astra-zeneca, Meda Pharmaceuticals and Seqirus. Larry Kalish is on the speakers' bureau for Care Pharmaceuticals, Mylan, and Seqirus Pharmaceuticals. All other authors have no personal, financial, or institutional interest in any drugs, materials, or devices described in this article. This is an unfunded project., (Copyright © 2024 Elsevier Inc. All rights reserved.)
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- 2024
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3. Usefulness of endoscopic endonasal underwater surgery using a combination of coblation and a lens-cleaning system for hemostasis in hereditary hemorrhagic telangiectasia.
- Author
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Sakaida H, Kobayashi M, and Takeuchi K
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- Humans, Aged, Male, Nasal Cavity surgery, Hemostasis, Endoscopic methods, Hemostasis, Endoscopic instrumentation, Endoscopy methods, Natural Orifice Endoscopic Surgery methods, Hemostasis, Surgical methods, Hemostasis, Surgical instrumentation, Telangiectasia, Hereditary Hemorrhagic complications, Telangiectasia, Hereditary Hemorrhagic surgery, Epistaxis surgery
- Abstract
Hemostatic procedures for controlling nasal bleeding in refractory diseases such as hereditary hemorrhagic telangiectasia (HHT) can be challenging. In this report, we present a novel technique for underwater endoscopic endonasal hemostatic surgery, which was performed on a 69-year-old man with HHT. The patient had been experiencing frequent episodes of nasal bleeding and had many telangiectasias in the nasal cavity, which were the cause of the bleeding. These telangiectasias were effectively treated using a coblation device in combination with an endoscope lens-cleaning system that supplied saline to create stable underwater conditions. There are several advantages to this technique, including provision of a stable and clear endoscopic field of view, allowing for better visualization of the surgical site. This makes it easier to identify bleeding points and ensure accurate hemostasis. Additionally, the hydrostatic pressure created by the underwater environment helps to reduce bleeding during the procedure. However, it is important to take careful precautions to prevent water from entering the lower airway. With this precautionary measure, this technique is particularly useful in managing bleeding in patients with HHT., Competing Interests: Declaration of competing interest The authors declare no conflicts of interest., (Copyright © 2024. Published by Elsevier B.V.)
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- 2024
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4. Posterior epistaxis management: review of the literature and proposed guidelines of the hellenic rhinological-facial plastic surgery society.
- Author
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Koskinas I, Terzis T, Georgalas C, Chatzikas G, Moireas G, Chrysovergis A, Triaridis S, Constantinidis J, and Karkos P
- Subjects
- Humans, Retrospective Studies, Risk Factors, Ligation methods, Randomized Controlled Trials as Topic, Epistaxis surgery, Surgery, Plastic
- Abstract
Purpose: Posterior epistaxis is a common emergency in ENT practice varying in severity and treatment. Many management guidelines have been proposed, all of which are a product of retrospective analyses due to the nature of this pathology, as large-scale double-blind studies are impossible-even unethical-to conduct. The purpose of this review is to perform a thorough analysis and comparison of every treatment plan available and establish guidelines for the best possible outcome in accordance to every parameter studied. Given the extensive heterogeneity of information and the multitude of studies on this topic, along with the comparison of various treatment options, we opted for a literature review as our research approach., Methods: A review of the literature was performed using PubMed Database and search terms included "posterior epistaxis", "treatment", "management", "guidelines", "algorithm" "nasal packing", "posterior packing", "surgery", "SPA ligation", "embolization", "risk factors" or a combination of the above., Results: Initial patients' assessment invariably results in most cases in posterior packing. There seems to be a superiority in recent literature of early surgery over nasal packing as a definitive treatment. Embolization is usually used after surgery failure, except for specific occasions., Conclusion: Despite the vast heterogeneity of information, there seems to be a need for re-evaluation of the well-established treatment plans according to more recent studies., (© 2023. The Author(s).)
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- 2024
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5. Managing recurrent nosebleeds in children: a retrospective review of 718 children attending a nurse-led epistaxis clinic.
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Drake I, Fountain H, and Kubba H
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- Child, Humans, Retrospective Studies, Neomycin, Nurse's Role, Cautery, Chlorhexidine, Epistaxis surgery, Epistaxis diagnosis
- Abstract
Objective: This review assessed the effectiveness of the nurse-led children's epistaxis clinic in streamlining patient care and avoiding unnecessary general anaesthesia., Methods: A retrospective case note review was conducted of children attending the nurse-led epistaxis clinic between 2019 and 2021., Results: A total of 718 children were seen over three years. Twelve (1.7 per cent) had a known coagulopathy. Of the children, 590 (82 per cent) had visible vessels and 29 (4 per cent) had mucosal crusting. Silver nitrate cautery was attempted under topical anaesthesia in 481 children, with 463 (96 per cent) successful cauterisations. Fifteen (3 per cent) were cauterised under general anaesthesia. Of the children, 706 (99 per cent) were prescribed nasal antiseptic preparations; this was the sole treatment for 58 (8 per cent). Blood investigations were requested for eight children (1 per cent) and haematology referral for three (0.4 per cent)., Conclusion: This is the largest published series of children's nosebleeds. Given the short-lived benefit from cautery, it is suggested that general anaesthesia should not be offered routinely. However, improved haematology referral criteria are required to increase underlying diagnosis.
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- 2024
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6. [Fundamentals and practice of the application of nasal packing in sinonasal surgery].
- Author
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Weber RK, Sommer F, Heppt W, Hosemann W, Kühnel T, Beule AG, Laudien M, Hoffmann TK, Hoffmann AS, Baumann I, Deitmer T, Löhler J, and Hildenbrand T
- Subjects
- Humans, Nose, Epistaxis prevention & control, Epistaxis surgery, Wound Healing, Endoscopy methods, Sinusitis surgery, Nasal Surgical Procedures methods
- Abstract
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.)
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- 2024
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7. Comparing recurrence between cautery techniques in pediatric epistaxis.
- Author
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Schafer AD, McNutt M, Fulmer A, Bourgeois T, and Elmaraghy CA
- Subjects
- Humans, Child, Retrospective Studies, Cautery adverse effects, Cautery methods, Electrocoagulation adverse effects, Silver Nitrate adverse effects, Recurrence, Epistaxis etiology, Epistaxis surgery, Epistaxis diagnosis, Neoplasm Recurrence, Local
- Abstract
Objective: To compare the risk of recurrent epistaxis between children treated with silver nitrate (SN) in the office or electrocautery (EC) in the operating room (OR)., Methods: Patients aged 2-18 diagnosed with epistaxis (ICD R04.0) in 2018 and treated with SN or EC were retrospectively reviewed. Epistaxis laterality, history of nasal trauma, and personal or family history of a bleeding disorder were recorded. Patients with prior cautery or epistaxis secondary to a procedure were excluded. Recurrence was defined as initial encounter after cautery with documented epistaxis. Patients were followed up into 2022 to track onset of recurrence. Time to recurrence between SN and EC was compared with hazard curves with predictors for recurrence analyzed via Cox's proportional hazard regression., Results: Among 291 patients cauterized for epistaxis, 62 % (n = 181) received SN compared to 38 % (n = 110) who underwent EC. There was significantly higher risk of recurrence when treated with SN compared to EC (Hazard ratio 2.45, 95 % CI: 1.57-3.82, P < 0.0001). Median time to recurrence was not statistically different between techniques (6.39 months (SN) (IQR: 2.33, 14.82) vs. 4.11 months (EC) (IQR: 1.18, 20.86), P = 0.4154). Complication rates were low for both groups (1.16 % (SN) vs. 0 % (EC), P > 0.05)., Conclusion: Among patients with epistaxis, risk of recurrence is significantly higher in those cauterized with SN compared to EC. Time to recurrence is not significantly different between cautery techniques., Competing Interests: Declaration of competing interest None., (Copyright © 2023 Elsevier B.V. All rights reserved.)
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- 2024
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8. Combined high-flow bypass and endovascular sacrifice for dysplastic cavernous internal carotid artery aneurysm for recurrent epistaxis.
- Author
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Gauden AJ, Dodd R, and Steinberg GK
- Subjects
- Humans, Epistaxis etiology, Epistaxis surgery, Carotid Artery, Internal diagnostic imaging, Carotid Artery, Internal surgery, Aneurysm complications, Aneurysm diagnostic imaging, Aneurysm surgery, Carotid Artery Diseases complications, Carotid Artery Diseases diagnostic imaging, Carotid Artery Diseases surgery, Intracranial Aneurysm complications, Intracranial Aneurysm diagnostic imaging, Intracranial Aneurysm surgery, Embolization, Therapeutic
- Abstract
Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
- Published
- 2023
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9. A low-cost prosthetic orbital simulation model for endoscopic anterior ethmoid artery ligation.
- Author
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Yapp J, Sebastian R, and Khwaja S
- Subjects
- Humans, Endoscopy, Epistaxis surgery, Ligation methods, Ethmoid Sinus surgery, Ethmoid Sinus blood supply, Ophthalmic Artery surgery
- Abstract
Objective: This study aimed to develop and evaluate a low-cost orbital prosthesis for simulation of endoscopically assisted intra-orbital anterior ethmoidal artery ligation., Methods: A low-cost orbital prosthesis was built and evaluated by ENT surgical trainees. Feedback was given following the assessment in the form of a face validity questionnaire., Results: Results were scored on a Likert scale of 1-7 (low to high). Trainees had limited exposure to the procedure (40 per cent) and predominantly low levels of confidence (mean, 3.67) that correlated with a lack of first-hand experience. The anatomy and likeness to human tissue of the prosthesis were both ranked highly, with mean scores of 5.0 and 4.93, respectively., Conclusion: The results of this study support the idea that a simple anatomical prosthesis for the simulation of endoscopic anterior ethmoidal artery ligation can be created with potential value to otolaryngology surgical training. To the authors' knowledge, this is the first documentation of simulated surgical epistaxis management using an artificial anatomical model.
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- 2023
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10. Anaesthetic management for caesarean section in a patient with hereditary haemorrhagic telangiectasia and severe epistaxis during pregnancy.
- Author
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Fogang D C, Martin G, Boehlen F, and Savoldelli GL
- Subjects
- Humans, Pregnancy, Female, Epistaxis etiology, Epistaxis surgery, Cesarean Section, Pregnancy Trimester, Third, Telangiectasia, Hereditary Hemorrhagic complications, Hemangioma, Anesthetics
- Abstract
A primigravida patient, with a history of hereditary haemorrhagic telangiectasia (HHT) manifesting as nasal angiodysplasia and hepatic arteriovenous malformations (AVM), presented for delivery planning and anaesthetic evaluation at 29 weeks of gestation. She was hospitalised several times during the second and third trimester for serious recurrent epistaxis, leading to severe anaemia. In total, she required the transfusion of 20 units of packed red blood cells during her pregnancy as well as surgical nasal haemostasis under general anaesthesia (GA). The patient was referred to our tertiary centre for delivery. In the context of recurrent severe epistaxis and high cardiac output (due to hepatic AVM) in the third trimester, a multidisciplinary decision was made to plan an elective caesarean section at 35 4/7 weeks combined with nasal packing under GA. This report discusses the implications of HHT, the multidisciplinary planning of the caesarean section, intraoperative anaesthetic management and patient follow-up., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2023
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11. How we do it: using the nasion as a landmark for identifying the anterior ethmoidal artery.
- Author
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Patel TA and Lubbe D
- Subjects
- Humans, Nose, Ligation methods, Orbit surgery, Epistaxis surgery, Ophthalmic Artery
- Abstract
Background: In severe refractory epistaxis, the anterior ethmoidal artery may need to be ligated. Previously described endonasal or transorbital approaches are not always effective, or they have suboptimal aesthetic outcomes. This paper describes a safe and effective surgical technique, with a consistent landmark allowing quick identification., Technical Description: A transcaruncular incision is made, oriented medially in the direction of the medial orbital wall towards the level of the nasion. Once onto bone, a subperiosteal plane is developed and an endoscope is used to dissect posteriorly at the level of the nasion, until the anterior ethmoidal artery is identified, and subsequently ligated., Conclusion: The nasion is an easy, constant landmark to use for ligation of the anterior ethmoidal artery in refractory epistaxis. The traditional method of identifying the anterior ethmoidal artery is not applicable or constant enough for use during the transorbital approach. The described technique avoids injury to surrounding structures and has a satisfactory aesthetic outcome.
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- 2023
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12. The Arterial Pattern of the Upper Nasal Septum (S-Point) and Potential Role in Severe Epistaxis.
- Author
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Rezende NC, Leonel LCPC, Kosugi EM, Pinheiro-Neto CD, and Peris-Celda M
- Subjects
- Humans, Arteries, Turbinates surgery, Cautery, Epistaxis surgery, Nasal Septum surgery, Nasal Septum blood supply
- Abstract
Objectives: The previously described S-point, corresponds to the medial projection of the middle turbinate axilla in the superior nasal septum and has been identified as a common source of severe epistaxis. The objective is to define the anatomical patterns of vascularization of the S-point area that could explain its clinical relevance., Methods: Thirty-three nasal septums of latex-injected formalin-embalmed and fresh human cadaveric heads were dissected to analyze the arterial arrangement of the S-point area. Measurements and patterns of vascularization were described., Results: The S-point area, was consistently surrounded by a single or multiple arterial anastomotic arches consistently formed superiorly by the anterior ethmoidal and posterior ethmoidal artery branches, and inferiorly by the posterior septal artery. The caliber of the arterial arches was typically larger than the caliber of the arterial branches supplying them. A single arch was present in 36.3% of septums, and multiple arches in 63.6%. The mean distance from the S-point to the anterior limit of the arch was 9 mm, to the posterior arch when the present was 3 mm, to the superior limit 6 mm, to the inferior limit 6 mm, and to the nasal roof was 10 mm., Conclusion: This study demonstrates the dense arterial configuration of the S point area, which is characterized by a single or multiple vascular arches of greater caliber than the branches of origin. This finding could explain why the S-point area is a frequent source of epistaxis, and guide its surgical cauterization when an obvious vascular ectasia is not visualized., Level of Evidence: N/A Laryngoscope, 133:2075-2080, 2023., (© 2022 The American Laryngological, Rhinological and Otological Society, Inc.)
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- 2023
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13. Factors affecting Naseptin treatment success - A prospective cohort study.
- Author
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Garry S, Wauchope J, Hintze JM, Ryan EJ, O'Cathain E, and Heffernan CB
- Subjects
- Child, Humans, Prospective Studies, Chlorhexidine therapeutic use, Cautery, Recurrence, Epistaxis surgery, Neoplasm Recurrence, Local
- Abstract
Objective: To assess patient factors to predict treatment success of Naseptin for recurrent paediatric epistaxis., Methods: This prospective cohort study of paediatric patients referred to a tertiary paediatric otolaryngology clinic with recurrent epistaxis treated with Naseptin cream and education. Patients with red flag symptoms and bleeding diathesis were omitted, along with patients with concurrent otolaryngology complaints. Statistical analysis included logistic regression analysis to assess for predictive factors contributing to treatment success., Results: 125 of 210 patients on the waiting list met the inclusion criteria and were given a complete trial of Naseptin. 80.8% (n = 101) of patients found that the frequency and severity of epistaxis had reduced, with the remaining 19.2% (n = 24) reporting that the episodes of epistaxis remained the same and required further management (i.e., silver nitrate cautery). Five patients (4%) reported minor side effects (skin irritation etc.) with no significant adverse events reported., Conclusion: We found that Naseptin is a safe, well-tolerated treatment that should be trialled in most cases of recurrent paediatric epistaxis. Most children will benefit from it with complete epistaxis cessation or at least reduced frequency and severity., Competing Interests: Declaration of competing interest The authors declare no conflicts of interest., (Copyright © 2023 Elsevier B.V. All rights reserved.)
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- 2023
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14. [Strategy of the diagnosis and treatment for epistaxis and guideline for clinical application of MasterPillar].
- Author
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Shi L
- Subjects
- Humans, Electrocoagulation, Treatment Outcome, Epistaxis therapy, Epistaxis surgery, Paranasal Sinuses
- Abstract
Epistaxis is a common otorhinolaryngological emergency with complex etiological factors and varied clinical manifestations. The key to epistaxis treatment is accurate diagnosis and adequate hemostasis. Electrocoagulation is a reliable, safe and effective treatment for epistaxis. However, there are still several deficiencies in application of the commonly used electrocoagulation surgical products. This paper introduces a new type of radiofrequency head incorporating the dynamic circulatory functions of drip, irrigation, hemostasis and aspiration. We aim to achieve noninvasive, effective and accurate hemostasis in the treatment of epistaxis or nasal sinus surgery., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)
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- 2023
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15. Endoscopic Sphenopalatine Artery Cauterization in the Management of Recurrent Posterior Epistaxis.
- Author
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Pop SS, Tiple C, Stamate MC, and Chirila M
- Subjects
- Humans, Retrospective Studies, Cautery methods, Arteries surgery, Endoscopy methods, Epistaxis surgery, Nose
- Abstract
Background and Objectives : Endoscopic sphenopalatine artery cauterization (ESPAC) has become a reliable and effective surgical procedure for managing posterior epistaxis. The objectives of our study were to evaluate the effectiveness of ESPAC in the management of posterior epistaxis and the possible factors that lead to the failure of the procedure. Materials and Methods : We performed a retrospective analysis of all patients who underwent ESPAC between 2018 and 2022. We retrospectively reviewed the demographic data, patients' co-morbidities, medical treatment conditions, whether other surgical procedures were performed in addition to the ESPAC, and the success rate of ESPAC. Results : 28 patients were included in our study. After ESPAC, epistaxis was successfully managed in 25 patients (89.28%). Of all patients undergoing ESPAC, three (10.7%) presented re-bleeding. In two patients, we performed an endoscopic revision surgery with re-cauterization of the sphenopalatine foramen area, together with anterior and posterior ethmoidectomy, followed by fat occlusion/obliteration of these sinuses. In one patient, fat obliteration of the anterior and posterior ethmoid was also unsuccessful, and we performed an external carotid artery ligation at the level of the neck with no recurrence afterwards. Conclusions : Endoscopic cauterization of the sphenopalatine artery remains a safe, effective, and reliable surgical procedure in the management of recurrent posterior epistaxis. The use of anticoagulant drugs and the association of hypertension and other heart and liver diseases do not materialize as factors influencing surgical failure.
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- 2023
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16. Comparison of the Ankaferd Blood Stopper Tampon and the Merocel Nasal Tampon after Septoplasty Surgery.
- Author
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Kar M, Cetinkaya EA, and Konşuk-Ünlü H
- Subjects
- Humans, Nasal Septum surgery, Prospective Studies, Postoperative Hemorrhage, Epistaxis complications, Epistaxis surgery, Pain, Postoperative, Nasal Obstruction surgery, Rhinoplasty adverse effects
- Abstract
Objective: In this study, we aimed to investigate the effects of the Ankaferd Blood Stopper (ABS) on nasal bleeding, pain, eating disorders, and sleeping problems in patients undergoing septoplasty., Methods: The prospective study included 100 patients who underwent septoplasty surgery. Patients were divided into two groups based on the chronological order of hospital admission: Group I was administered the ABS, and Group II was administered a standard Invotec Merocel nasal tampon. In both groups, the intensity of pain experienced by patients postoperatively during tampon use and tampon removal was assessed using the visual analogue scale (VAS)., Results: A significant difference was found between the two groups with regard to VAS scores assessed during tampon use. In the ABS group, the VAS scores assessed during tampon use were significantly lower, and the incidence of nasal obstruction, eating disorders, dripping-type bleeding before tampon removal, and sleeping problems was significantly lower in the ABS group than in the Merocel group., Conclusions: The ABS may be a viable alternative to other nasal packs, as it did not lead to a significant reduction in postoperative patient comfort during tampon use and caused a lower incidence of postoperative pain, eating disorders, sleeping problems, and nasal obstruction than standard Merocel tampons., Level of Evidence Iii: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 ., (© 2022. Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery.)
- Published
- 2023
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17. Transcaruncular anterior ethmoidal artery ligation.
- Author
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Fath L, Léon A, Djennaoui I, and Debry C
- Subjects
- Humans, Epistaxis etiology, Epistaxis surgery, Ligation methods, Ethmoid Sinus surgery, Ophthalmic Artery surgery, Nose
- Abstract
Recurrence of epistaxis after ligation or embolization of the sphenopalatine artery may require ligation of the ipsilateral anterior ethmoidal artery, which cannot be embolized because of the risk to the ophthalmic artery. We describe a transconjunctival transcaruncular approach that allows reliable low-risk access to the anterior ethmoidal artery. This technique offers a minimally invasive approach to the surgical site, without unsightly scar., (Copyright © 2022. Published by Elsevier Masson SAS.)
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- 2023
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18. Multi-layer reconstruction of skull base after endoscopic transnasal surgery for invasive pituitary adenomas.
- Author
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Xing M, Lv W, Liu P, Wang J, Gao W, Xu Y, Li Z, and Zhang L
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- Humans, Epistaxis surgery, Retrospective Studies, Skull Base diagnostic imaging, Skull Base surgery, Endoscopy methods, Cerebrospinal Fluid Leak etiology, Nasal Septum surgery, Plastic Surgery Procedures, Pituitary Neoplasms diagnostic imaging, Pituitary Neoplasms surgery, Adenoma diagnostic imaging, Adenoma surgery
- Abstract
Objective: To explore the efficacy of multi-layer skull base reconstruction after endoscopic transnasal surgery for invasive pituitary adenomas (IPAs)., Clinical Rationale for the Study: Skull base reconstruction for IPAs., Material and Methods: This retrospective analysis involved 160 patients with IPAs who underwent operations from October 2018 to October 2020. All patients were diagnosed with IPAs by pituitary enhanced magnetic resonance imaging, and all tumours were confirmed to be Knosp grades 3a, 3b, or 4. The experimental group and the control group comprised 80 patients in each, and we used different methods to reconstruct the skull base in each group. The comparison indicators included cerebrospinal fluid leakage, sellar floor bone flap (or middle turbinate) shifting, delayed healing of the skull base reconstructed tissue, nasal discomfort, and epistaxis. We used the chi-square test, and p < 0.05 was considered statistically significant., Results: In the experimental group, cerebrospinal fluid leakage occurred intraoperatively in 73 patients, two of whom had cerebrospinal fluid leakage postoperatively. Brain CT 12 months postoperatively showed no sellar floor bone flap (or middle turbinate) shifting. Endoscopic transnasal checks performed seven days after surgery showed that the skull base reconstructed tissue had healed in 74 patients and had failed to heal in six. However, endoscopic transnasal checks showed that all six of these patients' pedicled nasoseptal flaps had healed well by 14 days after surgery. Other sequelae comprised nasal discomfort in four patients, and epistaxis in four. In the control group, cerebrospinal fluid leakage occurred intraoperatively in 71 patients, 14 of whom had cerebrospinal fluid leakage postoperatively. Brain CT 12 months postoperatively showed floor bone flap (or middle turbinate) shifting in 12 patients. Endoscopic transnasal checks performed seven days after surgery showed that the skull base reconstructed tissue had healed in 65 patients. In 12 patients, pedicled nasoseptal flaps had healed well by 14 days after surgery, while the remaining three patients required reoperation. Other sequelae comprised nasal discomfort in five patients, and epistaxis in six., Conclusions: This new method of multi-layer skull base reconstruction could play an important role in endoscopic transnasal IPA surgery.
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- 2023
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19. [The effect of increased secretory activity of the nasal mucosa on the duration of the recovery period after anterior tamponade with gauze tampons during surgery of the nasal septum].
- Author
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Kiselev AB, Chaukina VA, Andamova OV, and Avtushko AS
- Subjects
- Male, Humans, Nasal Septum surgery, Epistaxis surgery, Phytotherapy, Tampons, Surgical, Nasal Mucosa, Rhinoplasty adverse effects
- Abstract
Objective: To assess the effect on the duration and course of the nasal mucosa function recovery after anterior nasal packing during surgery involving the nasal septum and inferior nasal conchae combined with concomitant therapy with the herbal medicinal product Sinupret extract (Bionorica SE, Germany)., Material and Methods: The study included 25 males aged 18-50 (the main group), permanent residents of the Novosibirsk region diagnosed with deviated nasal septum at least 2 years ago. All patients underwent rhinoseptoplasty with nasal packing with gauze tampons for 24 hours at the clinical base of the Otorhinolaryngology Department of the Novosibirsk State Medical University., Patients of the main group received Sinupret extract 1 tablet BID for 10 days before the planned rhinoseptoplasty and 7 days after the rhinoseptoplasty. Patients in control group 1 ( n =16) received Sinupret 2 coated tablets TID for 10 days before the surgery and 7 days after the surgery. Patients in control group 2 ( n =16) did not receive secretory therapy in the preoperative and postoperative periods of rhinoseptoplasty., Results: The herbal medicinal product improved nasal breathing. All studied parameters demonstrated the benefit of the treatment including Sinupret extract ( p <0.05). On day 5 in patients of the main study group, nasal breathing was normal, and nasal crusting was reduced due to activation of the mucous membrane secretory function. Nasal mucosa ciliary clearance was better in patients in the main group than in patients in the control groups at all stages of the study. Sinupret extract for 10 days before and 5 days after the surgery helps reduce nasal crusting and restore nasal breathing by day 2 and normalizes ciliary clearance by day 5 after nasal packing., Conclusion: Due to the wide use of nasal packing with gauze tampons, otorhinolaryngologists commonly administer herbal medicinal products as a means of drug protection of the nasal mucous membrane.
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- 2023
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20. Efficacy and safety of a hypertonic nasal wash solution containing sea algae extracts in patients that underwent surgical correction of a deviated nasal septum and radiofrequency turbinate volume reduction.
- Author
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Laskaris S, Georgiou S, Cingi C, and Alevizopoulos K
- Subjects
- Humans, Epistaxis surgery, Nasal Septum surgery, Sodium Chloride, Turbinates surgery, Hypertonic Solutions, Nasal Obstruction surgery, Rhinoplasty
- Abstract
Objective: The objective of this study was to evaluate efficacy and safety of a Hypertonic Seawater Solution (2.3% NaCl) containing brown and blue-green Algae (HSS-A) in comparison to Isotonic Saline Solution (ISS) regarding the improvement of nasal breathing in patients that have undergone surgical correction of a deviated nasal septum and radiofrequency turbinate volume reduction., Patients and Methods: A total of 101 individuals were enrolled in the study (HSS-A: 57; ISS: 44). Nasal breathing was evaluated using a Peak Nasal Inspiratory Flow (PNIF) measurement device at four timepoints: prior to surgical intervention (up to 30 days pre-surgery) and at the 2nd, 10th and 20th postoperative days. On the 20th postoperative day, patients also answered a Nasal Surgical Questionnaire (NSQ) evaluating breathing ability and overall satisfaction from the use of both nasal sprays., Results: No significant differences were observed in PNIF measurements between groups at different points. On the 20th postoperative day, NSQ analysis showed that ISS-treated patients had more frequently moderate nasal bleeding compared to the HSS-A group (85.7% vs. 14.3%, p=0.038). No other statistically significant differences were observed between groups. When NSQ parameters were evaluated in a binary mode, a trend for reduced crusting scores was seen in the HSS-A group (15.9% vs. 35.5% in ISS, p=0.053). No safety concerns were reported throughout the study., Conclusions: In patients that have undergone surgical correction of a deviated nasal septum and radiofrequency turbinate volume reduction, PNIF values did not differ significantly in patients receiving HSS-A and ISS solutions. Nasal bleeding was more frequent in ISS patients versus HSS-A. Overall, both solutions provided symptomatic relief and use satisfaction in the absence of side effects.
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- 2022
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21. Randomized, controlled, double-blinded clinical trial of effect of bevacizumab injection in management of epistaxis in hereditary hemorrhagic telangiectasia patients undergoing surgical cauterization.
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Khanwalkar AR, Rathor A, Read AK, Paknezhad H, Ma Y, and Hwang PH
- Subjects
- Bevacizumab therapeutic use, Cautery, Epistaxis drug therapy, Epistaxis etiology, Epistaxis surgery, Humans, Quality of Life, Vascular Endothelial Growth Factor A therapeutic use, Telangiectasia, Hereditary Hemorrhagic complications, Telangiectasia, Hereditary Hemorrhagic drug therapy, Telangiectasia, Hereditary Hemorrhagic surgery
- Abstract
Background: Given its role in the disease pathophysiology, inhibition of vascular endothelial growth factor (VEGF)-mediated angiogenesis has received attention as a potential strategy to reduce epistaxis associated with hereditary hemorrhagic telangiectasia (HHT). In this study we evaluated the efficacy of a submucosal injection of bevacizumab, a VEGF inhibitor, in reducing the severity of epistaxis and improving quality of life when given at the time of operative electrocautery., Methods: This randomized, double-blinded, placebo-controlled trial was conducted at a single institution from 2014 to 2019. Patients scheduled to undergo operative bipolar electrocautery of nasal telangiectasias were randomized to receive a submucosal injection of saline or bevacizumab at time of surgery. Surveys to assess epistaxis severity and quality of life (QOL), including the Epistaxis Severity Score (ESS) and the 12-item Short Form (SF-12), were administered preoperatively and at 1, 2, 4, and 6 months postoperatively. The minimal clinically important difference (MCID) of the ESS instrument is reported to be 0.71., Results: Of 39 patients enrolled, 37 (94.9%) completed the study. The saline group demonstrated a reduced ESS vs baseline at 1 (-1.2; p = 0.01) and 4 (-1.2; p = 0.05) months postprocedure. The bevacizumab group demonstrated a reduced ESS score vs baseline at 1 (-2.3; p < 0.001), 2 (-2.3; p < 0.001), 4 (-2.0; p = 0.003), and 6 (-1.3; p = 0.05) months postprocedure. The additive benefit of bevacizumab over saline exceeded the MCID at 1, 2, and 4 months, but the difference was not statistically significant., Conclusion: The addition of a single treatment of submucosal bevacizumab may be associated with additional clinically meaningful benefit for up to 4 months when compared with electrocautery alone., (© 2022 ARS-AAOA, LLC.)
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- 2022
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22. Overcorrection of Nasal Bone Fracture Reduction Can Be Minimized by Packing Removal.
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Hwang K and Ma SH
- Subjects
- Bandages, Epistaxis surgery, Fracture Fixation, Humans, Nasal Bone surgery, Rhinoplasty
- Abstract
Abstract: We experienced 16 cases of overcorrection among 524 cases of packing following nasal bone fracture (NBF) reduction. In these cases, the packing was removed immediately.From July 2017 to October 2020, 535 cases of NBF were reduced by closed reduction. Nasal packing was applied in 524 cases (97.9%). In all cases, postoperative X-rays (both nasal bone lateral view and Water's view) were taken. The degree of overcorrection was measured in the nasal bone lateral views.Among the 524 patients who underwent nasal packing, overcorrection was noted in 16 cases (3.1%). The average degree of overcorrection was 2.09 ± 0.70 mm. In these patients, the packing was removed immediately and X-rays were taken directly after packing removal. The degree of overcorrection decreased; however, no significant difference was found (1.83 ± 0.71 mm, P = 0.081, [paired t test]).In this study, overcorrection was noted in 3.1% of patients in whom nasal packing was applied. After packing removal, the degree of overcorrection decreased but was not significant. Postoperative X-rays should be taken after reduction of NBF and nasal packing, and if overcorrection is noticed, the packing should be removed immediately., Competing Interests: The authors report no conflicts of interest., (Copyright © 2021 by Mutaz B. Habal, MD.)
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- 2022
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23. Risk factors of epistaxis after endoscopic endonasal skull base surgeries.
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He W, Shen M, Chen Z, Ma Z, Qiao N, Zhang Y, Ye Z, Zhao Y, Shou X, and Wang Y
- Subjects
- Endoscopy methods, Humans, Male, Prostate-Specific Antigen, Retrospective Studies, Risk Factors, Skull Base surgery, Epistaxis epidemiology, Epistaxis etiology, Epistaxis surgery, Hypertension complications
- Abstract
Background: Epistaxis after endoscopic endonasal skull base surgeries does not typically occur as an accidental circumstance but often results from multiple factors. We aimed to assess the possible risk factors associated with postoperative epistaxis., Methods: Patients who underwent endoscopic endonasal skull base surgery at Huashan hospital from August 2018 to November 2019 were enrolled in the study. Postoperative epistaxis was defined as severe, persistent, or recurrent arterial nosebleed, which required therapeutic intervention. Patients were divided into the epistaxis and no epistaxis groups. The incidence, clinical characteristics, management, and intraoperative findings were recorded., Results: A total of 762 patients were included in the study. 20 (2.6%) patients experienced postoperative epistaxis, which happened in a delayed fashion between 6 and 30 postoperative days. Multivariate logistic regression analysis showed that arterial hypertension (OR=3.394, 95%CI: 1.094-10.531, P = 0.034) and preoperative systolic blood pressure (SBP) (OR=1.035, 95%CI: 1.002-1.068) were identified as predictors for postoperative epistaxis. The bleeding sites were identified at the left posterior septal artery (PSA) in 10 (62.5%) cases, the right PSA in 4 (25%) cases, the left palatovaginal artery in 1 (6.25%) case, and the right inferior turbinate branch of the posterior lateral nasal artery in 1 (6.25%) case, respectively. Direct bipolar cauterization was used to stop the bleeding. After definitive treatment, no patients had recurrent epistaxis., Conclusions: Arterial hypertension and preoperative SBP were associated with postoperative epistaxis after endoscopic endonasal skull base surgery, and the left PSA contributed to the dominant site of bleeding during surgical re-exploration., (Copyright © 2022. Published by Elsevier B.V.)
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- 2022
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24. Duration of effectiveness of coblation for recurrent epistaxis in hereditary hemorrhagic telangiectasia.
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Feller CN, Adams JA, Friedland DR, and Poetker DM
- Subjects
- Bevacizumab therapeutic use, Epistaxis etiology, Epistaxis surgery, Female, Humans, Retrospective Studies, Treatment Outcome, Telangiectasia, Hereditary Hemorrhagic complications, Telangiectasia, Hereditary Hemorrhagic drug therapy
- Abstract
Introduction: Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant disease leading to recurrent epistaxis, telangiectasias, and/or visceral arteriovenous malformations. Multiple treatment methods, including both pharmacologic and surgical, are described to be effective in managing symptomatic HHT. Few report the duration of symptom improvement for each of these treatment methods. This study aims to analyze the duration of effectiveness of coblation treatment for recurrent epistaxis in those with HHT., Methods: Retrospective single-center chart review was completed for patients diagnosed with HHT who underwent coblation treatment by the same otolaryngologist from December 2009 to November 2021. Demographic information was collected along with whether local Bevacizumab was used during each treatment. Months between treatment coblation sessions was used as a surrogate for duration of treatment effectiveness. Descriptive statistics were used for analysis alongside quantitative statistical analysis., Results: Over the course of 12 years, 57 patients (24 female, 42.11%) with HHT underwent a total number of 150 coblation treatments. The average age at initial coblation was 59 years (29-88) with an average follow-up time of 5 years (1-12 years). Of the 150 coblations, 30 treatments (20%) included bevacizumab injections into the nasal cavity. The average duration of treatment effectiveness across all 150 treatment sessions was 24.5 months (1-87 months). Of the 26 patients (46%) that underwent multiple coblation treatments, the overall average duration of coblation effectiveness was 16.4 months (1-72 mos). When Bevacizumab was utilized, the average duration of effectiveness was 18.3 months (3-62 mos), while the average duration of effectiveness for treatments without Bevacizumab was 15.7 months (1-87 mos, p > 0.251). Further, there was no correlation between duration of treatment effectiveness and age, sex, and race; yet,there was a significant negative correlation between the use of tobacco and duration of coblation effectiveness (p = 0.0202)., Conclusions: Coblation is an effective treatment option for the management of epistaxis in patients with HHT with duration of benefit lasting approximately 2 years. The use of Bevacizumab did not add to the duration of treatment benefit. Further, the duration of benefit was negatively impacted by smoking history., (Published by Elsevier Inc.)
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- 2022
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25. Recurrent Epistaxis Throughout the Lifespan: A Clinical Review.
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Schmidtman DC, Blaseg NA, and Likness MM
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- Cautery, Humans, Longevity, Embolization, Therapeutic, Epistaxis surgery, Epistaxis therapy
- Abstract
Epistaxis is a common otolaryngologic complaint experienced by 60 percent of the U.S. population and can be the result of either local or systemic disturbance. Most nosebleeds arise from an anastomotic region along the anterior nasal septum known as Kiesselbach's plexus. However, roughly ten percent of nosebleeds originate posteriorly from the sphenopalatine branch of the maxillary artery. Posterior nosebleeds can be more difficult to control and are frequently associated with systemic derangement. Patients presenting with a nosebleed should first be assessed for airway patency and hemodynamic stability. Once the patient is confirmed to be acutely stable, pre-existing clots should be cleared from the nasal cavity and the nasal alae should be compressed against the septum for ten to fifteen minutes. Application of a topical vasoconstricting agent can also be considered at this time. If the nosebleed persists and the location of the bleed can be visualized, chemical or electrical cautery can be used. If the site of the bleed cannot be identified, nasal packing materials in the form of lubricant-impregnated ribbon gauze or readymade nasal packing devices can be placed to tamponade the bleed. Following failure of these conservative treatment modalities, otolaryngologist consultation should be sought. Next steps in management may include arterial ligation or embolization., (Copyright© South Dakota State Medical Association.)
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- 2022
26. Sclerotherapy Versus Cautery/Laser Treatment for Epistaxis in Hereditary Hemorrhagic Telangiectasia.
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Woodard TD, Yappel-Sinkko KB, Wang X, McCrae KR, and Parambil JG
- Subjects
- Electrocoagulation adverse effects, Hemoglobins, Humans, Iron, Lasers, Postoperative Complications, Quality of Life, Retrospective Studies, Sclerotherapy methods, Epistaxis etiology, Epistaxis surgery, Telangiectasia, Hereditary Hemorrhagic therapy
- Abstract
Objectives/hypothesis: Surgical interventions for epistaxis management in hereditary hemorrhagic telangiectasia (HHT) demonstrate short-term success and require repeated procedures for disease control. Although electrocautery and/or laser photocoagulation (C ± L) are most frequently performed, sodium tetradecyl sclerotherapy (STS) is emerging as a promising newer treatment. We hypothesized that in a 24-month time period, STS would require fewer treatments than C ± L to maintain epistaxis severity within the mild range., Study Design: Retrospective study., Methods: We retrospectively assessed 67 patients with HHT with moderate and severe epistaxis that were treated periodically with C ± L (34 patients) versus STS (33 patients). The primary outcome was the number of procedures needed to maintain the epistaxis severity score (ESS) as mild. Secondary outcomes assessed for differences in postoperative complications, hemoglobin levels, iron stores, hematologic support, and quality-of-life (QoL) scores., Results: To maintain ESS in the mild range, 1.6 STS procedures (range, 1-4) were performed versus 3.6 C ± L procedures (range, 1-8) (P = .003). Significant postoperative differences included reduction in nasal crusting (3% vs. 32%, P = .001), foul odor (3% vs. 35%, P < .001), and septal perforation (3% vs. 29%, P = .006) after STS. There were no significant differences between the two treatments in hemoglobin levels, iron stores, hematologic support, or QoL scores., Conclusion: STS is able to attain satisfactory epistaxis control with significantly fewer procedures and lower postoperative complications than C ± L. STS should be considered as the initial surgical intervention for epistaxis in patients with HHT., Level of Evidence: 4 Laryngoscope, 132:920-925, 2022., (© 2021 The American Laryngological, Rhinological and Otological Society, Inc.)
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- 2022
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27. Why is there such variation in nasal cautery rates for childhood epistaxis: deprivation or clinician behaviour? National data from Scotland 2000-2019.
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Downie L and Kubba H
- Subjects
- Cautery, Child, Humans, Scotland, Epistaxis surgery, Nasal Surgical Procedures
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- 2022
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28. Recurrent epistaxis due to cribriform plate dural arteriovenous fistula: are they related? Should the treatment be from venous, pial or arterial side?
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Tripathi M, Kamal Ahuja C, Gupta A, Kumar Mukherjee K, Batish A, and Buddhiraja M
- Subjects
- Cerebral Angiography, Cranial Fossa, Anterior diagnostic imaging, Cranial Fossa, Anterior surgery, Epistaxis etiology, Epistaxis surgery, Ethmoid Bone, Humans, Male, Middle Aged, Central Nervous System Vascular Malformations complications, Central Nervous System Vascular Malformations diagnostic imaging, Central Nervous System Vascular Malformations surgery, Embolization, Therapeutic
- Abstract
Purpose: Dural arteriovenous fistula (DAVF) of the anterior cranial fossa with cortical venous reflux is an aggressive neurovascular entity with a high rate of intracranial bleeding. Only two cases of anterior cranial fossa DAVF presenting with epistaxis alone have been reported. Endovascular approaches have emerged as the primary and safer treatment modality for most DAVFs. Certain fistulas are better treated with open surgical approaches and disconnection., Case Description: A 55 years old male presented with the history of multiple episodes of severe epistaxis. Cerebral angiography revealed an anterior cranial fossa DAVF of the cribriform plate with cortical venous reflux and a venous varix. The patient was successfully managed with a bifrontal craniotomy and disconnection from the arterial side., Conclusion: Atypical or severe epistaxis may arise from a DAVF. Surgical arterial disconnection my be a curative treatment option.
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- 2022
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29. [Comprehensive assessment of the respiratory function of nasal packs with airway tubes].
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Kryukov AI, Tsarapkin GY, Bokshansky VB, Kishinevskii AE, Polyaeva MY, Zadorozhnaya AA, and Ulanova AS
- Subjects
- Humans, Nose surgery, Nasal Cavity surgery, Epistaxis surgery, Respiration, Nasal Septum surgery, Rhinoplasty adverse effects, Rhinoplasty methods, Nasal Obstruction diagnosis, Nasal Obstruction etiology, Nasal Obstruction surgery
- Abstract
Intranasal packs with breathing tubes are one of the possible methods of postoperative management of patients after endonasal surgery. The role of these devices is to provide the possibility of nasal breathing of patients to facilitate the course of the postoperative period. However, the possibility of providing proper nasal breathing with these devices has not been studied. The aim of the work is to study the calculated and clinical possibilities of nasal breathing when using intranasal packs with breathing tubes after endonasal surgical interventions., Material and Methods: We studied packs with air tubes from two manufacturers: Medtronic and Spiggle & Theis. During the experimental part, measurements of the air tubes and their study using acoustic rhinometry were carried out. In the clinical part, there were two groups of patients with different types of tampons and control group of volunteers with normal nasal breathing, the total number of participants was 45 people. All patients of groups 1 and 2 underwent septoplasty, bilateral lower partial conchotomy. In the postoperative period, rhinomanometry, rhinoflowmetry, a study of the duration of nasal breathing, and a subjective assessment of nasal breathing were performed., Results: According to measurements and acoustic rhinometry, the airway tubes of the tampons have a cross-sectional area that is more than 4 times smaller than the narrowest part of the nasal cavity in healthy volunteers. According to the results of a clinical study, the tampons in question are not able to provide a level of nasal breathing comparable to normal, even after clearing the lumen by a doctor. Medtronic packs provide somewhat better airway function due to the larger internal diameter of the tubes, but also do not create conditions for satisfactory nasal breathing., Conclusion: Improving the respiratory function of tampons in the future can be achieved by increasing the internal lumen of the breathing tubes while maintaining comfort of use.
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- 2022
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30. [Recurrent epistaxis associated with Randu-Osler disease, requiring ligation of the external carotid arteries on both sides].
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Izvin AI, Rudzevich AV, and Khatskelevich DM
- Subjects
- Carotid Arteries, Carotid Artery, External surgery, Humans, Ligation adverse effects, Nose, Epistaxis diagnosis, Epistaxis etiology, Epistaxis surgery, Telangiectasia, Hereditary Hemorrhagic complications
- Abstract
A rare clinical case of recurrent nosebleeds associated with Randu-Osler disease, in which drug, hemostatic, transfusion therapy and combined nasal tamponade were ineffective, required ligation of the external carotid arteries on both sides, is presented.
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- 2022
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31. Long-term efficacy assessment of current treatment options for epistaxis in HHT.
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Dür C, Anschuetz L, Negoias S, Bulut OC, Angelillo-Scherrer A, and Caversaccio M
- Subjects
- Bevacizumab, Humans, Light Coagulation, Retrospective Studies, Epistaxis surgery, Epistaxis therapy, Telangiectasia, Hereditary Hemorrhagic complications, Telangiectasia, Hereditary Hemorrhagic therapy
- Abstract
Purpose: Hereditary hemorrhagic telangiectasia (HHT) is a vascular disorder that presents with recurrent, intractable epistaxis. The aim of this study was to retrospectively analyze the efficacy of various treatment options for epistaxis in patients with HHT, over a period of 18 years, and to correlate these findings with available evidence in the literature., Methods: Records of patients with HHT, treated for epistaxis between 2000 and 2018 were analyzed. Treatment procedures carried out and their efficacy were extracted and analyzed., Results: Forty-three records were evaluated. All patients were given nasal humidifying ointments, 93% required acute treatment with bipolar electrocautery, and 60% underwent atraumatic nasal packing. Recurrent cases were treated medically with tranexamic acid (26%), oestrogen (19%), and bevacizumab (2%). Laser photocoagulation was done in selected cases (40%) and if unsuccessful, septal dermoplasty was performed (2.3%). Endovascular embolization was reserved for life-threatening emergencies (7%)., Conclusion: Epistaxis in HHT is not curable, but can be managed by employing a comprehensive stepwise approach. An algorithm for effective and comprehensive management has been presented., (© 2021. The Author(s).)
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- 2021
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32. How we do it: Surgery of the severe epistaxis with video.
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Bois J, Patron V, and Humbert M
- Subjects
- Humans, Epistaxis surgery
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- 2021
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33. Combination of a negative pressure suction device and endoscope can accurately locate the bleeding site of refractory epistaxis.
- Author
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Yin X, Zhang X, Wang B, Li K, and Duan M
- Subjects
- Case-Control Studies, Electrocoagulation, Female, Humans, Male, Middle Aged, Random Allocation, Retrospective Studies, Endoscopes, Epistaxis surgery, Suction instrumentation
- Abstract
Background: Selective endoscopic coagulation of a nasal bleeding vessel is an effective means of treating epistaxis. Precisely locating the bleeding site(s) is critical., Objective: To investigate the utility of combining a negative pressure suction device and endoscope in locating bleeding sites of refractory epistaxis., Methods: A total of 116 patients with refractory epistaxis, who underwent systematic endoscopic exploration under local anesthesia in the absence of identifiable sites of bleeding were randomizely divided into two groups via negative pressure group (NPG) and control group (CG): The negative pressure suction device combined with an endoscope was used to re-explore the epistaxis. Nasal bleeding was induced using this method to help the operator locate the site of epistaxis accurately; the bleeding was then stopped using electrocoagulation with the suction electrode. The CG was treated with endoscopic re-exploration and selective tamponade., Results: Compared with the CG, there were statistically significant differences in length of hospital stay, rebleeding, and postoperative pain and complications (all p < .05)., Conclusion and Significance: Combining a negative pressure suction device and endoscope was a safe and effective technique for accurately locating bleeding sites in patients with refractory epistaxis.
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- 2021
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34. Randomized Comparative Study of Microwave Ablation and Electrocautery for Control of Recurrent Epistaxis.
- Author
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Lou ZC and Jin KF
- Subjects
- Female, Humans, Male, Middle Aged, Prospective Studies, Recurrence, Treatment Outcome, Electrocoagulation methods, Epistaxis surgery, Microwaves therapeutic use, Radiofrequency Ablation methods
- Abstract
Objective: To compare the outcomes of adult patients with recurrent epistaxis treated intraoperatively with either bipolar electrocautery or microwave ablation (MWA)., Study Design: Prospective randomized control study., Materials and Methods: One hundred ten patients with idiopathic recurrent epistaxis who met the inclusion criteria were randomly assigned into MWA group and bipolar electrocautery group. Primary outcomes were the proportion of patients in each group whose bleeding had stopped within 24 hours after treatment and time to achieve successful hemostasis. Secondary outcomes were the rebleeding rate after 3 days, 1 and 12 weeks, and 6 months and complications., Results: Successful immediate arrest of epistaxis was achieved in all patients. The times to achieve successful hemostasis were 2.13 ± 1.04 minutes in the MWA group and 6.60 ± 2.68 minutes in the bipolar electrocautery group ( P = .000). The rates of recurrent bleeding were similar in patients treated with the different approaches ( P = .231). However, secondary crusting was observed endoscopically in 59 patients in the bipolar electrocautery group, while pseudomembrane of the ablation zone was seen in 19 (36.5%) patients in the MWA group. Nevertheless, there were no severe postoperative complications, including septal perforation and orbit and brain complications, in either group at the 6-month follow-up., Conclusion: Bipolar electrocautery and MWA had similar outcomes for the treatment of adult patients with recurrent epistaxis. However, MWA resulted in rapid hemostasis with less local nasal pain and less crust. Thus, MWA could be a favorable treatment option for patients with idiopathic recurrent epistaxis.
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- 2021
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35. The effect of the COVID-19 pandemic on non-elective otolaryngology admissions and a positive change in clinical practice.
- Author
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Wright B, McKenna C, and Reddy C
- Subjects
- Ambulatory Surgical Procedures standards, Ambulatory Surgical Procedures statistics & numerical data, COVID-19 epidemiology, COVID-19 transmission, Epistaxis surgery, Humans, Infection Control standards, Northern Ireland epidemiology, Otorhinolaryngologic Surgical Procedures standards, Otorhinolaryngologic Surgical Procedures statistics & numerical data, Pandemics prevention & control, Patient Admission standards, Patient Admission statistics & numerical data, Peritonsillar Abscess surgery, Retrospective Studies, Surgery Department, Hospital standards, Surgery Department, Hospital statistics & numerical data, Ambulatory Surgical Procedures trends, COVID-19 prevention & control, Otorhinolaryngologic Surgical Procedures trends, Patient Admission trends, Surgery Department, Hospital trends
- Abstract
As the COVID-19 pandemic progressed across the UK and Northern Ireland in March 2020, our otolaryngology department began to make preparations and changes in practice to accommodate for potentially large numbers of patients with COVID-19 related respiratory illness in the hospital. We retrospectively reviewed the number of non-elective admissions to our department between the months of January and May in 2019 and 2020. A significant reduction in admissions of up to 94% during the months of the pandemic was observed. Our practice shifted to manage patients with epistaxis and peritonsillar abscess on an outpatient basis, and while prospectively collecting data on this, we did not observe any significant adverse events. We view this as a positive learning point and change in our practice as a result of the COVID-19 pandemic.
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- 2021
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36. Nasal Cauterization with Silver Nitrate for Recurrent Epistaxis.
- Author
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Gudis DA and Soler ZM
- Subjects
- Cautery instrumentation, Humans, Nasal Cavity pathology, Nasal Mucosa blood supply, Physical Examination, Recurrence, Cautery methods, Epistaxis surgery, Nasal Mucosa surgery, Silver Nitrate administration & dosage
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- 2021
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37. Management of non-traumatic epistaxis in adults in the emergency department.
- Author
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Reed A, Barnes M, and Howard C
- Subjects
- Adult, Ambulances, Cautery, Emergencies, Humans, Retrospective Studies, Emergency Service, Hospital, Epistaxis surgery, Epistaxis therapy
- Abstract
Background/aims: Despite epistaxis being a common presentation to emergency departments there is a lack of guidelines, both nationally and internationally, for its management. The authors reviewed the current management of epistaxis and then introduced a new pathway for management to see if care could be improved. The aims were to evaluate the impact of the pathway on reduction of emergency department breaches, emergency ambulance transfers and hospital admissions., Methods: The study was an interrupted time series analysis over 29 months and included 903 participants. A pathway for the management of adults with non-traumatic epistaxis was designed and implemented in a university teaching hospital with an emergency department annual attendance rate of 105 495 in 2019-20., Results: The pathway led to a 14-minute longer stay in the emergency department, a 5% increase in emergency department breaches, an 8.2% reduction in admissions, a 3.6% reduction in emergency ambulance transfers, a 14.1% increase in nasal cautery and a 3.2% reduction in nasal packing., Conclusions: The authors calculate that these results equate to roughly 56 hospital bed days saved, providing better care closer to home for patients, in addition to beneficial knock-on effects for other emergency department and admitted patients.
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- 2021
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38. The role of computed tomography angiography as initial imaging tool for acute hemorrhage in the head and neck.
- Author
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Travis Caton M Jr, Miskin N, and Guenette JP
- Subjects
- Acute Disease, Adult, Aged, Aneurysm, False etiology, Aneurysm, False surgery, Angiography, Digital Subtraction, Contrast Media, Endovascular Procedures, Epistaxis etiology, Epistaxis surgery, Extravasation of Diagnostic and Therapeutic Materials diagnostic imaging, Female, Hemoptysis etiology, Hemoptysis surgery, Humans, Iohexol, Male, Middle Aged, Pharyngeal Diseases etiology, Pharyngeal Diseases surgery, Retrospective Studies, Risk Factors, Sensitivity and Specificity, Aneurysm, False diagnostic imaging, Computed Tomography Angiography methods, Epistaxis diagnostic imaging, Hemoptysis diagnostic imaging, Pharyngeal Diseases diagnostic imaging
- Abstract
Objectives: Acute hemorrhage in the head and neck (AHNH) is life-threatening due to asphyxiation and hemorrhagic shock. When conservative measures fail, some patients benefit from endovascular therapy (EVT). While CTA is routinely used to localize bleeding and plan EVT in gastrointestinal hemorrhage, the diagnostic value of CTA in AHNH and role of CTA in treatment-planning are uncertain., Methods: We retrospectively reviewed neck CTAs from June 2015 to October 2018 indicated for AHNH. When performed, digital subtraction angiography (DSA) findings and EVT were documented. Extravasation or pseudoaneurysm on DSA was considered positive for bleed localization., Results: Thirty CTA exams were performed for AHNH in 18 patients (mean age = 56.6, male% = 55.6%). Eleven out of 30 exams (36.7%) had immediate DSA follow-up within 24 h. Etiologies of hemorrhage included malignancy 11/18 (61.1%) and coagulopathy (4/18, 22.2%) among others. CTA reports identified definite or possible source of bleeding in 7/30 (23.3%) exams. Seven out of 7 (100%) patients with definite or possible source of bleeding on CTA underwent DSA and 4/23 (17.4%) patients underwent DSA despite negative CTA. With DSA as the gold standard, CTA had a sensitivity of 70% and a specificity of 100%., Conclusions: CTA has high specificity and reasonable sensitivity for detecting arterial source of bleeding in patients presenting with AHNH. Patients with negative CTA may avoid catheter angiography in most cases; however, false-negative CTA should not preclude angiography in high-risk patients.
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- 2021
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39. In-Office KTP Laser for Treating Hereditary Hemorrhagic Telangiectasia-Associated Epistaxis.
- Author
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Wu V, Kell E, Faughnan ME, and Lee JM
- Subjects
- Adult, Aged, Epistaxis congenital, Female, Humans, Male, Middle Aged, Retrospective Studies, Treatment Outcome, Ambulatory Surgical Procedures methods, Epistaxis surgery, Laser Coagulation methods, Lasers, Solid-State therapeutic use, Telangiectasia, Hereditary Hemorrhagic surgery
- Abstract
Objective: To evaluated the efficacy and safety of in-office potassium titanyl phosphate (KTP) laser treatment for the management of epistaxis in hereditary hemorrhagic telangiectasia (HHT) patients., Methods: A retrospective case series of all HHT patients over age of 18 who underwent in-office KTP laser treatment from July 1, 2017 to December 31, 2019 was performed. The primary outcome measure was the epistaxis severity score (ESS) pre- and post-procedure. Secondary outcome measures included patient reported pain (on a 10-point Likert-type scale), and procedural adverse events and complications., Results: A total of 16 patients underwent KTP in-office laser treatment during the review period. There was both a clinically and statistically significant decrease in the ESS after in-office laser treatment, baseline ESS -7.24, SD 1.71, follow up ESS -4.92, SD 1.83 (mean difference 2.94, 95% confidence interval, 1.83-4.04, P < .0001). There were no reported adverse events or complications associated with the procedure. The mean pain score reported was 0.19, SD 0.75. The average blood loss was 10.8 mL, SD 37.3. The majority of patients (62.5%, 10/16) had no blood loss during the procedure., Conclusion: Clinically and statistically significant decreases were noted in the ESS of HHT patients after in-office KTP laser photocoagulation. The procedure was well tolerated by patients, without any adverse events or complications., Level of Evidence: 4 Laryngoscope, 131:E689-E693, 2021., (© 2020 The American Laryngological, Rhinological and Otological Society, Inc.)
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- 2021
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40. Endoscopic surgical treatment of epistaxis in hereditary haemorrhagic telangiectasia: our experience.
- Author
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Pagella F, Pusateri A, Maiorano E, Spinozzi G, Ugolini S, Lizzio R, Mirabella R, Tinelli C, Olivieri C, and Matti E
- Subjects
- Humans, Longitudinal Studies, Retrospective Studies, Endoscopy, Epistaxis complications, Epistaxis surgery, Telangiectasia, Hereditary Hemorrhagic complications
- Abstract
Objectives: Hereditary haemorrhagic telangiectasia (HHT) is a rare autosomal dominant disease characterised by epistaxis. Surgical procedures for epistaxis vary from diathermocoagulation to nasal closure. The aim of this paper is to report our experience in endoscopic surgical management of epistaxis in HHT patients., Methods: This is a descriptive, longitudinal study carried out at the Otorhinolaryngology Department of IRCCS Policlinico San Matteo in Pavia, a reference centre for the treatment and diagnosis of HHT. We retrospectively evaluated HHT patients who underwent surgery for epistaxis from 1996 to 2015, including only those treated with endoscopic surgery., Results: Among the 591 patients hospitalised and screened for HHT, 323 (54.7%) underwent endoscopic surgery for epistaxis, for a total of 679 procedures. General anaesthesia was used in 77.2% of procedures; argon plasma coagulation was the instrument of choice in the majority of patients, followed by lasers and quantum molecular resonance technology., Conclusions: We report one of the largest cohorts undergoing endoscopic treatment of epistaxis in HHT patients. This mini-invasive surgical treatment allowed us to control epistaxis without major complications and nasal packaging and can be repeated over time. For these reasons, we recommend it as first choice in case of epistaxis in HHT patients., (Copyright © 2021 Società Italiana di Otorinolaringoiatria e Chirurgia Cervico-Facciale, Rome, Italy.)
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- 2021
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41. Response to Stephen Garry's letter to the editor regarding IJPORL-D-20-01098 - The addition of silver nitrate cautery to antiseptic nasal cream for patients with epistaxis: A systematic review and meta-analysis.
- Author
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Alsaif A, Karam M, Alhaider A, Almazeedi A, Aldubaikhi A, and Alfayez A
- Subjects
- Cautery, Epistaxis surgery, Humans, Ointments, Anti-Infective Agents, Local, Silver Nitrate
- Published
- 2021
- Full Text
- View/download PDF
42. Success Rate of Endoscopic Sphenopalatine Artery Ligation for the Management of Refractory Posterior Epistaxis Patients in a Tertiary Care Hospital: A Descriptive Cross-sectional Study.
- Author
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Basnet M, Ghimire B, Shrestha A, and Aryal GR
- Subjects
- Arteries, Cross-Sectional Studies, Female, Humans, Ligation, Male, Retrospective Studies, Tertiary Care Centers, Treatment Outcome, Epistaxis etiology, Epistaxis surgery, Maxillary Artery
- Abstract
Introduction: Epistaxis is a common medical emergency with 5% to 15% of patients admitted for epistaxis will require surgical management as nasal packing has high failure rates. A modern endoscopic technique like Endoscopic Sphenopalatine Artery Ligation has increased in popularity for managing intractable posterior epistaxis. It has less complication and a high success rate. The study conducted to estimate the success rate of Endoscopic Sphenopalatine Artery Ligation of refractory posterior epistaxis among admitted patients in a tertiary care hospital., Methods: This is a descriptive cross-sectional study conducted from June 2019 to June 2020 at the Department of Otorhinolaryngology, Nobel Medical College and Teaching Hospital among the patient with refractory posterior epistaxis with the help of retrospective data. A convenient sampling method was used. These patients underwent endoscopic sphenopalatine artery cauterization for recurrent/intractable posterior epistaxis. Ethical clearance was taken from the Institutional Review Board. Data were analyzed in Statistical Package for the Social Sciences., Results: Out of the total patient with refractory posterior epistaxis who underwent Endoscopic Sphenopalatine Artery Ligation, the overall success rate was 39 (95.12%). Among them, 25 (60.97%) males and 16 (39.02%) females underwent endoscopic sphenopalatine artery ligation. Twenty (48.78%) of them were unilateral whilst 21 (51.21%) were bilateral disease. About 2 (4.8%) cases had re-bleeding within 48 hours which was managed conservatively. Hypertension was found to be the most common comorbid condition followed by diabetes, chronic kidney., Conclusions: From our study, we conclude that the success rate for Endoscopic Sphenopalatine Artery Ligation in a patient with refractory posterior epistaxis was high.
- Published
- 2020
- Full Text
- View/download PDF
43. Endoscopic sphenopalatine artery electrocoagulation for refractory epistaxis: a clinical study.
- Author
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Yu L, Li X, Sun S, Shi L, and Wan Y
- Subjects
- Adult, Aged, Arteries surgery, Electrocoagulation adverse effects, Endoscopy, Female, Humans, Male, Middle Aged, Prognosis, Retrospective Studies, Electrocoagulation methods, Epistaxis surgery, Nasal Cavity blood supply
- Abstract
Background: The electrical coagulation of sphenopalatine artery(SPA) under nasal endoscopy has gradually become an important surgical intervention for epistaxis., Aim: To investigate the effectiveness and complications of SPA electrocoagulation for epistaxis., Material and Methods: The clinical data of 47 patients undergoing SPA electrocoagulation were analyzed, retrospectively., Results: Forty-seven patients were enrolled, with a male to female ratio of approximately 3:1. 11of 36 were under 45 years old, 25 of 36were 45 years old and above. Among female patients, one was under 45 years old, and the others were 45 years old and above, but there was no significant difference in gender composition between different age groups ( χ
2 = 1.069, p = .301). All patients were unilateral epistaxis. The effective control rates of epistaxis within 24 h after surgery, early postoperative, and late postoperative were 100%, 100%, and 97.9%, respectively. There were 6 patients with complications, including 3 patients with nasal dryness and ecdysis on the affected side, 2 patients with numbness on upper lip, 1 patient with nasal adhesion and pus on affected side., Conclusion and Significance: Refractory epistaxis has no relationship with age and sex, SPA electrcoagulation can effectively control refractory epistaxis and is an effective surgical method.- Published
- 2020
- Full Text
- View/download PDF
44. The role of endoscopic sphenopalatine artery ligation in the management of persistent epistaxis - A 15-year single-center experience.
- Author
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Tessler I, Warman M, Sharav S, Rotem Batito H, Halperin D, and Cohen O
- Subjects
- Female, Humans, Male, Middle Aged, Retrospective Studies, Time Factors, Treatment Outcome, Arteries surgery, Electrocoagulation methods, Endoscopy methods, Epistaxis surgery, Ligation methods, Otorhinolaryngologic Surgical Procedures methods, Sphenoid Sinus blood supply
- Abstract
Purpose: Managing persistent epistaxis poses a great challenge for the otolaryngologist. Despite continuous development in treatment methods, no universal guideline has been commonly adopted. Among the popular methods is endoscopic sphenopalatine artery ligation (ESPAL). This study aims to evaluate the impact of ESPAL integration on persistent epistaxis management over 15 years in a single academic center., Methods: A retrospective study including all cases who were hospitalized due to persistent epistaxis and required intervention between 2000 and 2016. From 2011, ESPAL was routinely utilized in our center, hence the study population was divided based on admission year, prior to 2011 (pre-ESPAL) and from 2011 till the end of data collection (post-ESPAL)., Results: The pre-ESPAL group included 87 interventions and the post-ESPAL group 54 interventions. Electrocautery remained the most common intervention in both periods. However, ESPAL incorporation was accompanied by a significant decline in the use of posterior nasal packing in the post-ESPAL group. The hemoglobin recovery levels and the mortality rates were significantly improved in the post-ESPAL group compared with the pre-ESPAL group despite higher comorbidity rates among the post-ESPAL patients., Conclusions: This study demonstrates the shifting trend in managing persistent epistaxis, and suggests that ESPAL has successfully replaced posterior nasal packing. These findings may encourage clinicians to consider ESPAL as a valuable tool in the management of persistent epistaxis., (Copyright © 2020 Elsevier Inc. All rights reserved.)
- Published
- 2020
- Full Text
- View/download PDF
45. Is prophylactic ablation reasonable for the management of idiopathic recurrent epistaxis?
- Author
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Li X
- Subjects
- Humans, Recurrence, Epistaxis prevention & control, Epistaxis surgery, Microwaves
- Published
- 2020
- Full Text
- View/download PDF
46. Hemorrhagic tonsillitis in an infant: A case report.
- Author
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Wilson JD, Zeisler B, and Grover N
- Subjects
- Endoscopy, Epistaxis diagnosis, Female, Humans, Infant, Palatine Tonsil surgery, Tonsillitis diagnosis, Tonsillitis etiology, Epistaxis etiology, Epistaxis surgery, Palatine Tonsil blood supply, Tonsillitis surgery
- Abstract
This case report describes a case of severe hemorrhagic tonsillitis in a nine month-old child who suffered significant amount of blood loss and was emergently taken to operating room for control of hemorrhage. The child was brought to emergency room by mom after noticing blood around child's mouth and nose and a subsequent episode of hematemesis having awoken from sleep. Initial impression was bleeding secondary to epistaxis however a thorough bedside otolaryngology exam including flexible rhinolaryngoscopy ruled this out. Rapid pooling of blood in oropharynx, continued hemorrhage with significant blood loss and recent history of hematemesis prompted emergent intervention in operating room for endoscopy for control of hemorrhage including esophagogastroduodenoscopy (EGD). Bleeding was identified from a blood vessel at left lower tonsil pole. Although there is a description in literature of such cases, these are uncommon in the pediatric population and none has been described in a patient this young requiring emergent operative intervention. This case report discusses the diagnostic and decision making dilemma in an infant in setting of ongoing active hemorrhage and the role of multidisciplinary team management., (Copyright © 2020 Elsevier B.V. All rights reserved.)
- Published
- 2020
- Full Text
- View/download PDF
47. Endoscopic sphenopalatine foramen cauterization is an effective treatment modification of endoscopic sphenopalatine artery ligation for intractable posterior epistaxis.
- Author
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Chitsuthipakorn W, Seresirikachorn K, Kanjanawasee D, and Snidvongs K
- Subjects
- Arteries surgery, Endoscopy, Humans, Ligation, Retrospective Studies, Cautery, Epistaxis surgery
- Abstract
Purpose: Endoscopic sphenopalatine artery ligation (ESPAL) is known as an effective treatment for posterior epistaxis. Anatomical variations of the intranasal branching may result in long operative time and possible inadequate cauterization. A modification of ESPAL by cauterization at the sphenopalatine foramen (SPF), has been performed by our group. Our study assessed the clinical benefit of endoscopic sphenopalatine foramen cauterization (ESFC) and compared it to ESPAL., Method: A retrospective study was conducted. Patients who received ESFC for posterior epistaxis from 2016 to 2018 at a tertiary hospital were recruited. Middle meatal antrostomy was done. After ethmoidal crest was identified and nipped, pterygopalatine fossa was entered through the SPF. Sphenopalatine artery (SPA) and its branches within the SPF were cauterized without identification of any SPA distal branches in the nasal cavity. Patients receiving conventional ESPAL by the same surgeon were recruited and compared as control. Patients were followed-up for 3 months. Success rate, operative time, and complication were assessed., Results: Thirty-four patients were identified. Recurrent epistaxis was absent in 90.0% and 100% of patients receiving ESPAL (9/10 patients) and ESFC (24/24 patients) respectively, p = 0.294. Median operative time was 115 and 60 min, respectively, p < 0.001. Ipsilateral hard palatal or anterior palatal numbness were found in one and three patients, respectively. All resolved spontaneously within 2 weeks., Conclusion: ESFC is effective in treating posterior epistaxis. It requires significantly less amount of time while the success rate was comparable to conventional ESPAL.
- Published
- 2020
- Full Text
- View/download PDF
48. Epistaxis From an Unusual Site: An Endoscopic View.
- Author
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Lee JH and Jeong HM
- Subjects
- Aged, Endoscopy, Epistaxis diagnostic imaging, Humans, Male, Medical Illustration, Turbinates diagnostic imaging, Cautery, Epistaxis etiology, Epistaxis surgery, Turbinates blood supply, Turbinates surgery
- Published
- 2020
- Full Text
- View/download PDF
49. Patient-recorded benefit from nasal closure in a Danish cohort of patients with hereditary haemorrhagic telangiectasia.
- Author
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Andersen JH and Kjeldsen AD
- Subjects
- Adult, Aged, Cohort Studies, Denmark, Epistaxis etiology, Female, Humans, Male, Middle Aged, Nasal Mucosa surgery, Nasal Surgical Procedures adverse effects, Patient Reported Outcome Measures, Patient Satisfaction, Surgical Flaps surgery, Telangiectasia, Hereditary Hemorrhagic complications, Treatment Outcome, Epistaxis surgery, Nasal Surgical Procedures methods, Nose surgery, Telangiectasia, Hereditary Hemorrhagic surgery
- Abstract
Background: Nasal closure, also known as the modified Young's procedure was introduced in Denmark in 2008, as a surgical solution to severe epistaxis in patients with hereditary haemorrhagic telangiectasia (HHT). The objective of this study was to report the overall satisfaction of the procedure from a patient's point of view as well as the occurrence of complications., Methods: All the HHT patients who underwent nasal closure from 2008 to 2018 were included in the study. The patients were evaluated for postoperative complications and subjective outcome using Glasgow Benefit Inventory (GBI)., Results: Ten patients were included in the study and were observed for a mean of 64 months. None of the patients was completely free of complications, and reversal was requested in a single case. Haemoglobin levels rose with an average of 2.8 g/dl. The average GBI score after surgery was 38.05. Nine of ten patients would recommend nasal closure to fellow HHT patients., Conclusion: Nasal closure is highly recommended among patients, but due to the rate of postoperative complications, the procedure should be reserved for a carefully selected group of HHT patients.
- Published
- 2020
- Full Text
- View/download PDF
50. Comparison of microwave ablation and chemical cautery used to control adult idiopathic recurrent anterior epistaxis.
- Author
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Lou Z
- Subjects
- Adult, Female, Humans, Male, Nasal Septum surgery, Silver Nitrate administration & dosage, Treatment Outcome, Cautery methods, Epistaxis surgery, Hemostasis, Surgical methods, Microwaves therapeutic use, Radiofrequency Ablation methods
- Abstract
Objective: This study compared the efficacy of microwave ablation and silver nitrate cautery as treatments for idiopathic recurrent anterior epistaxis in adults., Methods: A case series with chart review was conducted. Adults with recurrent anterior epistaxis intra-operatively treated via microwave ablation or silver nitrate chemical cautery of the anterior nasal septum were enrolled. The primary outcomes were the proportion of patients in each group for whom bleeding ceased within 24 hours of treatment, and the time to successful haemostasis. The secondary outcomes were re-bleeding rates at 1 and 12 weeks and 6 months, and complications., Results: The haemostasis success rate within 24 hours' treatment of convex lesions was significantly higher in the microwave ablation group than in the cautery-only group. Of patients with convex lesions, the recurrence rate to six months was significantly higher in the cautery group than in the microwave ablation group, but this was not the case for those with flat lesions., Conclusion: Microwave ablation afforded rapid and simple haemostasis for adults with recurrent anterior epistaxis in an out-patient setting. Microwave ablation had significant advantages compared to silver nitrate cautery when used to treat epistaxis in patients with convex lesions.
- Published
- 2020
- Full Text
- View/download PDF
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