Journal List > J Rhinol > v.25(2) > 1109237

TOOLS
Lee, Lee, Ryu, Seo, Hong, Kim, Dhong, and Chung: Efficacy of Endoscopic Electrocauterization for Recurrent Posterior Epistaxis
CASE REPORT

J Rhinol 2018;25(2):75-79.

Published online: 19 January 2018

DOI: https://doi.org/10.18787/jr.2018.25.2.75

Efficacy of Endoscopic Electrocauterization for Recurrent Posterior Epistaxis

Jung Joo Lee, MD, Eunkyu Lee, MD, Gwanghui Ryu, MD, Min Young Seo, MD, Sang Duk Hong, MD, Hyo Yeol Kim, MD, Hun-Jong Dhong, MD, Seung-Kyu Chung, MD

Departments of Otorhinolaryngology-Head and Neck Surgery Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

교신저자：정승규, 06351 서울 강남구 일원로 81 성균관대학교 의과대학 삼성서울병원 이비인후-두경부외과학교실 Tel: +82-2-3410-3579, Fax: +82-2-3410-3879, E-mail: rhinochung@gmail.com

Received 18 August 2017       Revised 31 October 2017       Accepted 5 December 2017

Copyright © 2018 Journal of Rhinology

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background and Objectives:

To investigate the common site of recurrent epistaxis after initial intervention such as packing and cauterization had failed and to evaluate the efficacy of surgical endoscopic electrocautery.

Subjects and Method:

Retrospective review of 47 patients with recurrent and uncontrolled idiopathic epistaxis between October 1995 and March 2016. All patients underwent endoscopic examination in the operating room after hospitalization. We performed electrocautery when a bleeding site was found.

Results:

The most common sites of bleeding were the inferior meatus (28%), sphenoethmoid recess (23%), superior septum around the olfactory cleft (13%), and the posterior end of the middle turbinate (15%). There was no serious complication during the one week after surgery. In 46 (98%) patients, refractory epistaxis was successfully controlled. One patient had recurrent epistaxis after electrocautery and underwent endoscopic sphenopalatine artery ligation.

Conclusion:

In patients with refractory idiopathic epistaxis after failure of first-line treatment, endoscopic examination through a surgical approach and electrocautery for suspected bleeding are effective.

Keywords: Epistaxis, Posterior bleeding, Electrocauterization.

REFERENCES

1). Rudmik L., Smith TL. Management of intractable spontaneous epistaxis. Am J Rhinol Allergy. 2012. 26(1):55–60.
crossref
2). Reyre A., Michel J., Santini L., Dessi P., Vidal V., Bartoli JM, et al. Epistaxis: The role of arterial embolization. Diagn Interv Imaging. 2015. 96(7-8):757–73.
crossref
3). Parajuli R. Evaluation of Etiology and Treatment Methods for Epistaxis: A Review at a Tertiary Care Hospital in Central Nepal. Int J Otolaryngol. 2015. 2015:283854.
crossref
4). Zou Y., Deng YQ., Xiao CW., Kong YG., Xu Y., Tao ZZ, et al. Comparison of outcomes between endoscopic surgery and conventional nasal packing for epistaxis in the posterior fornix of the inferior nasal meatus. Pak J Med Sci. 2015. 31(6):1361–5.
crossref
5). Rudmik L., Leung R. Cost-effectiveness analysis of endoscopic sphenopalatine artery ligation vs arterial embolization for intractable epistaxis. JAMA Otolaryngol Head Neck Surg. 2014. 140(9):802–8.
crossref
6). Kumar S., Shetty A., Rockey J., Nilssen E. Contemporary surgical treatment of epistaxis. What is the evidence for sphenopalatine artery ligation? Clinical Otolaryngology & Allied Sciences. 2003. 28(4):360–3.
7). Elden L., Montanera W., Terbrugge K., Willinsky R., Lasjaunias P., Charles D. Angiographic embolization for the treatment of epistaxis: a review of 108 cases. Otolaryngology—Head and Neck Surgery. 1994. 111(1):44–50.
crossref
8). Bent JP., Wood BP. Complications resulting from treatment of severe posterior epistaxis. The Journal of Laryngology & Otology. 1999. 113(03):252–4.
crossref
9). Brinjikji W., Kallmes DF., Cloft HJ. Trends in epistaxis embolization in the United States: a study of the Nationwide Inpatient Sample 2003-2010. Journal of Vascular and Interventional Radiology. 2013. 24(7):969–73.
crossref
10). Liu Y., Zheng C., Wei W., Liu Q. Management of intractable epistaxis: endoscopy or nasal packing? J Laryngol Otol. 2012. 126(5):482–6.
crossref
11). Pletcher SD., Metson R. Endoscopic ligation of the anterior ethmoid artery. The Laryngoscope. 2007. 117(2):378–81.
crossref
12). Jones N., Woolford T. Endoscopic ligation of anterior ethmoidal artery in treatment of epistaxis. Journal of Laryngology & Otology. 2000. 114(11):858–60.
crossref
13). Lim SK., Joo EJ., Kang KS., Wee SJ., Kang JH., Park JM. Clinical analysis of refractory epistaxis. Korean Journal of Otolaryngology-Head and Neck Surgery. 2005. 48(9):1111–4.

Table 1.
Preoperative patient characteristics
Patient characteristics  
Number of patients 47
Age (yr±SD) 51.1±14.6
M : F 34 (72%) : 13 (28%)
Hypertension 23 (49%)
Anticoagulant medication 6 (13%)
Duration of epistaxis prior to surgery  
    ≤24 hr 6 (13%)
    24＜ ≤72 hr 9 (19%)
    ＞72 hr 32 (68%)
Hemoglobin on admission (g/L)  
    ≥12.0 16 (34%)
    10.0≤ Hb＜12.0 11 (23%)
    8.0≤ Hb＜10.0 11 (23%)
＜8.0 2 (4%)
Not checked 7 (15%)
Number of needing transfusion 16 (34%)
Table 2.
Bleeding focus and operative procedure
Operative and lesion characteristics Number (%)
General anesthesia 39 (83%)
Local anesthesia 8 (17%)
Bleeding focus  
  Inferior meatus 13 (28%)
  Sphenoethmoidal recess 11 (23%)
  Superior septum around olfactory cleft 6 (13%)
  MT posterior end 7 (15%)
  MT antrolateral surface 4 (9%)
  Anterior septum 2 (4%)
  Not checked 4 (9%)
Electrocauterization 45 (96%)
Concomitant procedure  
  Septoplasty 9 (19%)
  MMA or EMMA or FEMMA 4 (9%)
  IT outfracture 17 (36%)
  MT partial resection or outfracture 5 (11%)

MT: middle turbinate, IT: inferior turbinate, MMA: middle meatal antrostomy, EMMA: ethmoidectomy and middle meatal antrostomy, FEMMA: frontal sinusotomy, ethmoidectomy and middle meatal antrostomy

Table 3.
Postoperative course and complications
Postoperative course  
Admission period (day±SD) 4.1±2.8
Mean of follow-up period (day) 46.4
Complication  
  Re-bleeding 1 (2%)
  Synechia 4 (9%)
  Severe (nasal tip necrosis, facial numbness, hemiparesis etc.) 0
TOOLS
Similar articles