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Koskinas I, Terzis T, Georgalas C, Chatzikas G, Moireas G, Chrysovergis A, Triaridis S, Constantinidis J, Karkos P. Posterior epistaxis management: review of the literature and proposed guidelines of the hellenic rhinological-facial plastic surgery society. Eur Arch Otorhinolaryngol 2024; 281:1613-1627. [PMID: 38032485 PMCID: PMC10943169 DOI: 10.1007/s00405-023-08310-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023]
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.
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Affiliation(s)
- Ioannis Koskinas
- 1st Academic Otolaryngology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Kiriakidi 1 Str, 546 21, Thessaloniki, Greece.
| | - Timoleon Terzis
- Hellenic Rhinological-Facial Plastic Surgery Society, Thessaloniki, Greece
| | - Christos Georgalas
- Hellenic Rhinological-Facial Plastic Surgery Society, Thessaloniki, Greece
| | - Georgios Chatzikas
- Hellenic Rhinological-Facial Plastic Surgery Society, Thessaloniki, Greece
| | - Georgios Moireas
- Hellenic Rhinological-Facial Plastic Surgery Society, Thessaloniki, Greece
| | | | - Stefanos Triaridis
- 1st Academic Otolaryngology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Kiriakidi 1 Str, 546 21, Thessaloniki, Greece
| | - Jannis Constantinidis
- 1st Academic Otolaryngology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Kiriakidi 1 Str, 546 21, Thessaloniki, Greece
| | - Petros Karkos
- 1st Academic Otolaryngology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Kiriakidi 1 Str, 546 21, Thessaloniki, Greece
- Hellenic Rhinological-Facial Plastic Surgery Society, Thessaloniki, Greece
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Sundarajan K, Mani S, Arumugam K. Management of Recurrent and Refractory Posterior Epistaxis by Transnasal Endoscopic Sphenopalatine Artery Cauterization: a Prospective Cohort Study. Indian J Otolaryngol Head Neck Surg 2023; 75:2792-2797. [PMID: 37974743 PMCID: PMC10645779 DOI: 10.1007/s12070-023-03793-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 04/10/2023] [Indexed: 11/19/2023] Open
Abstract
Transnasal endoscopic sphenopalatine artery occlusion procedures are becoming the standard of care for intractable posterior epistaxis. Improved endoscopic anatomical features of the lateral nasal wall and endoscopic skill with high-resolution cameras result in a higher success rate of endoscopic intervention. To evaluate the safety and effectiveness of endoscopic cauterization of the sphenopalatine artery (ESPAC) in controlling intractable posterior nasal bleeding. This prospective cohort study enrolled patients with refractory posterior epistaxis from August 2016 to December 2019. The trial recruited patients between 18 and 65 years of age with a history of recurrent and refractory posterior epistaxis receiving endoscopic arterial cauterization due to conservative treatment failure. All of the cases involved bipolar cauterization. Recurrent nosebleeds must pause for at least three months for a procedure to be considered successful. In the first 30 days following surgery, complications are recorded. 415 patients with epistaxis received both inpatient and outpatient care. Transnasal ESPAC was necessary for 36 patients (11.5%). The most common comorbidity was hypertension accounting for 9 (23%) cases. Thus, 26 of 36 (72%) cases had a unilateral ESPAC, while 10 (28%) had a bilateral ESPAC. Twenty-two (61%) and ten (28%) patients had single and two branching patterns of the sphenopalatine artery, respectively. Septal correction and middle meatus antrostomy (44%) were the most performed additional procedures. During the three-month follow-up period, 35 patients in this study had epistaxis control; the success rate of ESPAC was 97.2%. There were no significant postoperative complications found. Endoscopic sphenopalatine artery cauterization is successful in controlling 97.2% of posterior epistaxis. It is safe and effective without any significant complications.
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Affiliation(s)
- Karthik Sundarajan
- Upgraded Institute of Otorhinolaryngology, Rajiv Gandhi Government General Hospital, Madras Medical College, Chennai, Tamil Nadu 600003 India
| | - Suresh Mani
- Department of Head and Neck Surgery, CMC, Vellore, India
| | - Karthiga Arumugam
- Upgraded Institute of Otorhinolaryngology, Rajiv Gandhi Government General Hospital, Madras Medical College, Chennai, Tamil Nadu 600003 India
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El Naamani K, Morse C, Ghanem M, Barbera J, Amllay A, Severance G, Ruiz R, Sweid A, Gooch MR, Herial NA, Jabbour P, Rosenwasser RH, Nyquist GG, Tjoumakaris S. Endovascular Embolization for Epistaxis: A Single Center Experience and Meta-Analysis. J Clin Med 2023; 12:6958. [PMID: 38002574 PMCID: PMC10672438 DOI: 10.3390/jcm12226958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/03/2023] [Accepted: 11/05/2023] [Indexed: 11/26/2023] Open
Abstract
The optimal treatment for intractable epistaxis is still controversial. Various studies have demonstrated high success rates and low complication rates for endovascular embolization. Herein, the authors report an institutional experience and meta-analysis in terms of efficacy and safety of endovascular embolization of intractable epistaxis. This was a retrospective observational study of 35 patients with epistaxis who underwent 40 embolization procedures between 2010 and 2023. The primary outcome was immediate success defined by immediate cessation of epistaxis at the end of the procedure. Immediate success was achieved in most of the procedures (39, 97.5%). During follow-up, three (7.5%) patients experienced a rebleed. Forty-one studies from 3595 articles were identified for inclusion in the meta-analysis and comprised 1632 patients. The mean pooled age was 57.5 years (95% CI: 57.2-57.8) and most patients were males (mean: 70.4, 95% CI: 69.8-71.0). Immediate success was achieved at a pooled mean of 90.9% (95% CI: 90.4-91.4) and rebleeding was observed at a pooled mean of 17% (95% CI: 16.5-17.5). In conclusion, endovascular embolization proved to be both safe and effective in treating intractable epistaxis carrying a low risk of post-operative stroke.
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Affiliation(s)
- Kareem El Naamani
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA; (K.E.N.); (C.M.); (J.B.); (G.S.); (R.R.); (A.S.); (M.R.G.); (N.A.H.); (P.J.); (R.H.R.)
| | - Charles Morse
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA; (K.E.N.); (C.M.); (J.B.); (G.S.); (R.R.); (A.S.); (M.R.G.); (N.A.H.); (P.J.); (R.H.R.)
| | - Marc Ghanem
- School of Medicine, Lebansese American University, Beirut 1102-2801, Lebanon;
| | - Julie Barbera
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA; (K.E.N.); (C.M.); (J.B.); (G.S.); (R.R.); (A.S.); (M.R.G.); (N.A.H.); (P.J.); (R.H.R.)
| | - Abdelaziz Amllay
- School of Medicine, Hassan II University, Casablanca 8118, Morocco;
| | - Grace Severance
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA; (K.E.N.); (C.M.); (J.B.); (G.S.); (R.R.); (A.S.); (M.R.G.); (N.A.H.); (P.J.); (R.H.R.)
| | - Ramon Ruiz
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA; (K.E.N.); (C.M.); (J.B.); (G.S.); (R.R.); (A.S.); (M.R.G.); (N.A.H.); (P.J.); (R.H.R.)
| | - Ahmad Sweid
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA; (K.E.N.); (C.M.); (J.B.); (G.S.); (R.R.); (A.S.); (M.R.G.); (N.A.H.); (P.J.); (R.H.R.)
| | - Michael R. Gooch
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA; (K.E.N.); (C.M.); (J.B.); (G.S.); (R.R.); (A.S.); (M.R.G.); (N.A.H.); (P.J.); (R.H.R.)
| | - Nabeel A. Herial
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA; (K.E.N.); (C.M.); (J.B.); (G.S.); (R.R.); (A.S.); (M.R.G.); (N.A.H.); (P.J.); (R.H.R.)
| | - Pascal Jabbour
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA; (K.E.N.); (C.M.); (J.B.); (G.S.); (R.R.); (A.S.); (M.R.G.); (N.A.H.); (P.J.); (R.H.R.)
| | - Robert H. Rosenwasser
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA; (K.E.N.); (C.M.); (J.B.); (G.S.); (R.R.); (A.S.); (M.R.G.); (N.A.H.); (P.J.); (R.H.R.)
| | - Gurston G. Nyquist
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA;
| | - Stavropoula Tjoumakaris
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA; (K.E.N.); (C.M.); (J.B.); (G.S.); (R.R.); (A.S.); (M.R.G.); (N.A.H.); (P.J.); (R.H.R.)
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Peri-operative complications of sphenopalatine artery ligation: a 10-year series from two secondary care centres. The Journal of Laryngology & Otology 2022; 136:1249-1253. [DOI: 10.1017/s0022215122000275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Background
There is currently limited evidence regarding the potential complications of sphenopalatine artery ligation. The post-operative outcomes at two secondary care centres over a 10-year period were reviewed.
Methods
A retrospective review was undertaken of patients undergoing emergency and elective sphenopalatine artery ligation between January 2011 and January 2021. Their demographics, peri-operative care and post-operative outcomes were recorded. The median follow-up time was 54 days (range, 0–2657 days).
Results
Ninety-one patients were included. Four patients (4.4 per cent) had a septal perforation at post-operative review. Nineteen patients (20.9 per cent) had post-operative bleeding that extended their in-patient stay, with five patients (5.5 per cent) requiring revision surgery. Pre-operative non-dissolvable nasal packing was used a median of 1 time (range, 0–8 times).
Conclusion
Further research on outcomes of sphenopalatine artery ligation is needed. Pre-operative non-dissolvable nasal packing, concurrent septal surgical procedures, surgical techniques, and co-morbidities such as hypertension represent potential confounding factors that could not be further assessed in this small, retrospective study.
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Yin X, Zhang X, Wang B, Li K, Duan M. Combination of a negative pressure suction device and endoscope can accurately locate the bleeding site of refractory epistaxis. Acta Otolaryngol 2021; 141:929-933. [PMID: 34633896 DOI: 10.1080/00016489.2021.1965652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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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Affiliation(s)
- Xinghong Yin
- Department of Otolaryngology-Head & Neck Surgery, Fuyang people’s Hospital, Fuyang, China
| | - Xinhai Zhang
- Department of Otolaryngology-Head & Neck Surgery, Fuyang people’s Hospital, Fuyang, China
| | - Bo Wang
- Department of Otolaryngology-Head & Neck Surgery, Fuyang people’s Hospital, Fuyang, China
| | - Keliang Li
- Department of Otolaryngology-Head & Neck Surgery, Fuyang people’s Hospital, Fuyang, China
| | - Maoli Duan
- Division of Ear, Nose and Thoat Disease, Department of Clinical Science, Intervention and Technology karolinska Institutet, Stockholm, Sweden
- Ear Nose and Throat Patient Area, Trauma and Reconstructive Medicine, Karolinska University Hospital, Stockholm, Sweden
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Galili J, Holm Nissen M, Ovesen T. Outcome of treatment for severe epistaxis: nasal packing and endoscopic sphenopalatine artery ligation. RHINOLOGY ONLINE 2021. [DOI: 10.4193/rhinol/20.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background: Severe epistaxis is a frequent emergency condition encountered by otolaryngologists and is often treated with nasal packing. In the event of failure surgical treatment is considered. We aimed to evaluate the efficacy of Nasal Packing (NP) and Endoscopic Sphenopalatine Artery Ligation (ESPAL) as treatment of severe epistaxis in terms of failures and recurrences including risk factors. Methodology: Retrospective descriptive study of patients with epistaxis treated with NP, admitted to an ENT department from 2011-2017. If initial treatment with NP failed, patients were considered for ESPAL. Results: An analysis of 511 patients was performed. All patients were treated with NP at the time of admission, and 14% of pa- tients were treated with ESPAL due to failure of NP. The majority of patients was only admitted once. Twelve percent were readmit- ted within 30 days, 7% were readmitted >30 days later. Treatment failure after ESPAL was 7.9%. No significant difference in the risk of readmission was found between patients treated with NP alone and patients treated with ESPAL. Conclusion: The majority of epistaxis patients were effectively treated with NP alone. We found good effect of ESPAL although no significant differences in risk of readmission NP vs. ESPAL were identified.
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Basnet M, Ghimire B, Shrestha A, Aryal GR. 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. JNMA J Nepal Med Assoc 2020; 58:1056-1060. [PMID: 34506371 PMCID: PMC8028521 DOI: 10.31729/jnma.5855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Indexed: 11/22/2022] Open
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 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. 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%) case 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.
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Affiliation(s)
- Meenakshi Basnet
- Department of Otorhinolaryngology and Head and Neck Surgery, Nobel Medical College and Teaching Hospital, Biratnagar, Nepal
| | - Bibek Ghimire
- Department of Otorhinolaryngology and Head and Neck Surgery, Nobel Medical College and Teaching Hospital, Biratnagar, Nepal
| | - Akriti Shrestha
- Department of Otorhinolaryngology and Head and Neck Surgery, Nobel Medical College and Teaching Hospital, Biratnagar, Nepal
| | - Gyan Raj Aryal
- Department of Otorhinolaryngology and Head and Neck Surgery, Nobel Medical College and Teaching Hospital, Biratnagar, Nepal
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Lau K, Stavrakas M, Ray J. Lasers in Rhinology-An Update. EAR, NOSE & THROAT JOURNAL 2020; 100:77S-82S. [PMID: 32703032 DOI: 10.1177/0145561320940115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES A wide and evolving range of lasers and their applications often makes it difficult for a busy surgeon to choose the ideal laser for a specific indication. With this in mind, this article aims to summarize the most recent literature concerning laser application in rhinology. METHODS A literature search from 2000 to 2020 using the PubMed database was employed. Keywords used included "laser," "rhinology," "endonasal endoscopic surgery," "hereditary haemorrhagic telangiectasia," "rhinitis," "refractory rhinitis," "Inferior turbinate hypertrophy," "dacryocystorhinostomy," "septoplasty," "cartilage reshaping" and "choanal atresia." The most up to date studies published for each rhinology condition that could potentially be treated with laser surgery was included. RESULTS Rhinological conditions appropriate for laser applications are discussed. We identified articles related to a number of applications including hereditary hemorrhagic telangiectasia, rhinitis, turbinate surgery, dacryocystorhinostomy, septoplasty, choanal atresia, and sphenopalatine artery ligation, paying attention to the outcomes of the studies and their limitations. CONCLUSIONS There is currently no one-size-fits-all laser and therefore being up to date on the latest clinical application results can help the clinician decide which are the best treatments to offer their patients.
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Affiliation(s)
- Kimberley Lau
- Otolaryngology Department, 7318Sheffield Teaching Hospitals, Sheffield, United Kingdom
| | - Marios Stavrakas
- Otolaryngology Department, 7318Sheffield Teaching Hospitals, Sheffield, United Kingdom
| | - Jaydip Ray
- Otolaryngology Department, 7318Sheffield Teaching Hospitals, Sheffield, United Kingdom
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Usefulness of computed tomography in predicting ethmoidal arterial bleeding in refractory epistaxis. Eur Arch Otorhinolaryngol 2020; 277:1969-1975. [PMID: 32170420 DOI: 10.1007/s00405-020-05914-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 03/03/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Epistaxis that is refractory to conservative management can be treated with endoscopic sphenopalatine artery ligation (ESPAL). Although rare, ethmoidal artery (EA) bleeding can be a cause of rebleeding after successful ESPAL. EA bleeding is diagnosed by angiography and can also be identified during surgical exploration. However, since the angiographic embolization of the EA is contraindicated, surgical hemostasis is mandatory. This study investigated whether paranasal sinus (PNS) CT could provide information for predicting EA bleeding without angiography in patients with refractory epistaxis requiring ESPAL. METHODS Forty-seven patients, who were surgically treated [with ESPAL or EA ligation (EAL)] for refractory epistaxis from March 2010 to June 2019, were retrospectively analyzed. A positive PNS CT finding for EA bleeding was defined as the presence of soft tissue densities having continuity with the EA pathway, accompanied by a partially deficient surrounding bony canal. These findings as well as soft tissue densities in each paranasal sinus were compared between the ESPAL and EAL groups. RESULTS All patients in the EAL group had positive CT findings of EA bleeding, compared to only 12.2% in the ESPAL group (P < 0.001). The rate of soft tissue densities within the frontal and sphenoid sinuses were noted in 26.8% and 17.1% of patients in the ESPAL group, compared to 83.3% and 83.3% of patients in the EAL group (P = 0.013 and P = 0.003, respectively). CONCLUSION PNS CT might be useful for predicting EA bleeding in patients with refractory epistaxis requiring surgical hemostasis.
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Wu B, Li H, Fan Y, Wang X, Li W, Zhong S, Ren J, Chen Y, Zhang L, Zhao G. Clinical and anatomical study of foramen locations in jaw bones and adjacent structures. Medicine (Baltimore) 2020; 99:e18069. [PMID: 31914012 PMCID: PMC6959958 DOI: 10.1097/md.0000000000018069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
This study aims to find and locate foramens exactly in maxilla and mandible in case of complications during surgeries.Computer topographic angiography (CTA) images of 120 cases were reviewed. The measurements were performed on coronal, sagittal and axial planes after the 3 dimension volume reconstruction. The distances among foramens, bony landmarks, teeth, and facial artery were all measured with the angles as adjustments.The incisive foramen (IF) was measured 20.55 ± 2.81 mm to margo inferior of incisor, and 45.27 ± 5.27 degree from the axial midline. The greater palatine foramen located 43.17 ± 2.55 mm from the IF, while 21.08 ± 3.75 degree from the midline in axial plane. The lesser palatine foramina located 44.56 ± 5.74 mm from the IF and 20.05 ± 3.59 degree to the midline. The Mandibular foramen (MBF) was 91.15 ± 1.86 mm horizontally to the margo inferior of incisor. The angle that the MBF-margo inferior of incisor line made with the axial midline was 31.25 ± 2.89 degree. The shortest horizontal distance from the mental foramen (MF) to the facial artery in sagittal plane was 21.90 ± 1.86 mm, while it became 13.00 ± 2.05 mm in coronary section. The horizontal distance from the MF to the margo inferior of incisor in sagittal plane was 22.04 ± 3.22 mm. It turned out to be 25.78 ± 5.23 mm between MF and mid-sagittal line in coronary section. The vertical distance was 25.20 ± 3.06 mm from the upper margin of the second premolar to the MF.The foramens were clearly seen through CTA. Moreover, linear and angular measurements were presented, which makes it safer and wiser for surgeons to consider the biometric data before operations.
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Affiliation(s)
- Bo Wu
- Clinical College, Jilin University
- Department of Orthopaedics, the First Hospital of Jilin University, Changchun, China
| | - Hui Li
- Clinical College, Jilin University
| | - Yuxiang Fan
- Department of Neurosurgery
- Clinical College, Jilin University
| | | | | | - Sheng Zhong
- Department of Neurosurgery
- Clinical College, Jilin University
| | | | | | - Lei Zhang
- Department of Radiology, the First Hospital of Jilin University
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Lou ZC, Jin KF. Randomized Comparative Study of Microwave Ablation and Electrocautery for Control of Recurrent Epistaxis. EAR, NOSE & THROAT JOURNAL 2019; 100:509-515. [PMID: 31597530 DOI: 10.1177/0145561319879238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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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Affiliation(s)
- Zheng-Cai Lou
- Department of Otorhinolaryngology, Yiwu Central Hospital, Zhejiang, China
| | - Kan-Feng Jin
- Department of Otorhinolaryngology, Yiwu Central Hospital, Zhejiang, China
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Smith J, Hanson J, Chowdhury R, Bungard TJ. Community-based management of epistaxis: Who bloody knows? Can Pharm J (Ott) 2019; 152:164-176. [PMID: 31156729 DOI: 10.1177/1715163519840380] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Jenna Smith
- Alberta Health Services (Smith), University of Alberta Hospital.,Anticoagulation Management Services (Hanson), University of Alberta Hospital.,Division of Otolaryngology Head and Neck Surgery (Chowdhury), University of Alberta, Edmonton, Alberta.,Division of Cardiology (Bungard), University of Alberta, Edmonton, Alberta
| | - Jennifer Hanson
- Alberta Health Services (Smith), University of Alberta Hospital.,Anticoagulation Management Services (Hanson), University of Alberta Hospital.,Division of Otolaryngology Head and Neck Surgery (Chowdhury), University of Alberta, Edmonton, Alberta.,Division of Cardiology (Bungard), University of Alberta, Edmonton, Alberta
| | - Raiyan Chowdhury
- Alberta Health Services (Smith), University of Alberta Hospital.,Anticoagulation Management Services (Hanson), University of Alberta Hospital.,Division of Otolaryngology Head and Neck Surgery (Chowdhury), University of Alberta, Edmonton, Alberta.,Division of Cardiology (Bungard), University of Alberta, Edmonton, Alberta
| | - Tammy J Bungard
- Alberta Health Services (Smith), University of Alberta Hospital.,Anticoagulation Management Services (Hanson), University of Alberta Hospital.,Division of Otolaryngology Head and Neck Surgery (Chowdhury), University of Alberta, Edmonton, Alberta.,Division of Cardiology (Bungard), University of Alberta, Edmonton, Alberta
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Severe Recurrent Epistaxis - The Main Symptom of Hereditary Haemorrhagic Teleangiectasia. ACTA MEDICA MARTINIANA 2019. [DOI: 10.2478/acm-2018-0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract
Hereditary haemorrhagic telangiectasia (HHT), also known as Rendu-Osler-Weber syndrome, is of dominant autosomal inheritance. Pathologic changes of vascular walls cause recurrent episodes of bleeding from many organ systems. Recurrent epistaxis is the first and the most frequent symptom of HHT. The causal therapy is not known but there are many therapeutic procedures improving the overall condition.
We present a case of a 76-year-old man suffering from HHT, frequently hospitalized and treated for massive nose bleeding. In past a selective arterial embolization was performed thrice; nonetheless, the intensity and frequency of epistaxis remained unchanged. Anterior nasal package and electrocoagulation were performed repeatedly as the “first aid” treatment. In the article we also mention other therapeutic modalities for this diagnosis; unfortunately, their efficacy remains inadequate.
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Huyett P, Jankowitz BT, Wang EW, Snyderman CH. Endovascular Embolization in the Treatment of Epistaxis. Otolaryngol Head Neck Surg 2019; 160:822-828. [PMID: 30744478 DOI: 10.1177/0194599819829743] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The cost-effectiveness of endovascular embolization (EE) for intractable epistaxis has been questioned, especially as endoscopic surgical techniques have become standard of care at many institutions. Our objectives were to review the safety profile and effectiveness of EE for epistaxis. STUDY DESIGN Retrospective case series. SETTING Tertiary care hospital. SUBJECTS There were 54 patients and 64 unique encounters. Patients were 66.7% male, with a mean age of 64.5 years. Bleeding disorders were present in 18.8%, hypertension was present in 71.7%, and 61.1% were on anticoagulant/platelet drugs. METHODS Charts of patients undergoing EE for epistaxis between 2005 and 2015 were retrospectively reviewed. RESULTS The immediate bleeding control rate was 92.6%. Three patients died within 1 week of EE and were excluded from further analysis. Overall, 64.7% of the remaining patients had no further episodes of epistaxis. Thirteen patients (25.4%) rebled within 1 week, 11 of whom required repeat EE or operative control. Five patients (9.8%) rebled more than 1 week following the procedure with 4 requiring repeat EE or operative control. The major complication rate was 7.4% and included transient stroke, diplopia, facial skin necrosis, and extraperitoneal hemorrhage. CONCLUSION While the immediate success rate of EE for epistaxis was comparable to the literature, the overall short- and long-term rebleed rate was high in this selected population. The results suggest that patients who are referred for EE represent a high-risk group with increased risk of repeat hemorrhage and morbidity. Patients who undergo EE for epistaxis should be carefully monitored for complications, including repeat hemorrhage.
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Affiliation(s)
- Phillip Huyett
- 1 Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Brian T Jankowitz
- 2 Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Eric W Wang
- 1 Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Carl H Snyderman
- 1 Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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15
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Hey SY, Koo Ng NKF, McGarry GW. Endoscopic Sphenopalatine Artery Ligation: General Applicability in a Teaching Unit. EAR, NOSE & THROAT JOURNAL 2019; 98:85-88. [PMID: 30884999 DOI: 10.1177/0145561319828675] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND: Endoscopic sphenopalatine artery ligation (ESPAL) is the intervention of choice for refractory epistaxis in specialist ear, nose and throat (ENT)units and should be within the repertoire of competencies for all ENT trainees. Following its recent incorporation within the United Kingdom competency-based training syllabus as an explicit outcome standard, the ESPAL is not uncommonly being delivered by trainees under appropriate supervision. We assessed the efficacy and outcome of ESPAL in epistaxis management within our teaching hospitals. METHODS: Retrospective, structured review of all ESPAL procedures performed for epistaxis between December 2005 and December 2013. The techniques of ligation, operator grade, and outcome were studied. RESULTS: Sixty-five patients (41 male:24 female; average age of 58.2 years) were identified in whom 67 artery ligations were performed (63 unilateral; 2 bilateral). Overall, success rate of ESPAL was 92.3% (60/65), with 5 rebleed cases recorded within 30 days of the primary procedure. Sixteen (24.6%) underwent "clipping," 26 (40.0%) had diathermy ligation, 18 (27.7%) had both clipping and diathermy, and in 5 (7.7%) patients, the ligation technique was not recorded. In 31 (47.7%) of 65 cases, a consultant was the principal surgeon. The remaining 34 (52.3%) of 65 cases were performed by trainees with (24, 70.6%) or without (10, 29.4%) supervision. There was no correlation between rebleed and operators' grade, level of supervision, or ligation technique. CONCLUSION: With appropriate training, ESPAL can achieve hemostasis in teams of varying grades of operators without significant reduction in outcome. To further enhance the technical learning curve, the utility of simulation-based training could offer continuous and longitudinal development of skills.
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Affiliation(s)
- Shi Ying Hey
- 1 Department of Otolaryngology-Head and Neck Surgery, Glasgow Royal Infirmary, Glasgow, United Kingdom
| | - Nigel K F Koo Ng
- 1 Department of Otolaryngology-Head and Neck Surgery, Glasgow Royal Infirmary, Glasgow, United Kingdom
| | - Gerald W McGarry
- 1 Department of Otolaryngology-Head and Neck Surgery, Glasgow Royal Infirmary, Glasgow, United Kingdom
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Kitamura T, Takenaka Y, Takeda K, Oya R, Ashida N, Shimizu K, Takemura K, Yamamoto Y, Uno A. Sphenopalatine artery surgery for refractory idiopathic epistaxis: Systematic review and meta-analysis. Laryngoscope 2019; 129:1731-1736. [PMID: 30613985 DOI: 10.1002/lary.27767] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Epistaxis, especially posterior epistaxis, is occasionally refractory to treatment. In these cases, sphenopalatine artery surgeries, including cauterization and ligation, are required. Previous reports have demonstrated treatment results for these procedures but failed to provide high-level evidence. The aim of this study was to quantify the rates of failure and perioperative complications of these procedures by using a meta-analysis technique. METHODS We systematically searched electronic databases and identified articles regarding epistaxis, sphenopalatine artery ligation, or cauterization. Pooled rebleeding and complication rates were calculated by using a random effects model. RESULTS A total of 896 cases of sphenopalatine ligation or cauterization for epistaxis were analyzed. Pooled rebleeding rates for the entire cohort, cauterization group, and ligation group were 13.4% (95% confidence interval [CI] 10.0-17.8, P < 0.001), 7.2% (95% CI 4.6-11.0, P < 0.001), and 15.1% (95% CI 9.8-22.5, P < 0.001), respectively. Pooled perioperative complication rates for the entire cohort, cauterization group, and ligation group were 8.7% (95% CI 4.9-15.1, P < 0.001), 10.2% (95% CI 3.8-24.5, P < 0.001), and 6.4% (95% CI 1.8-20.9, P < 0.001), respectively. CONCLUSION Overall, sphenopalatine surgery for refractory epistaxis is an effective method because of its low rates of failure and complications. Cauterization is more effective than ligation, whereas complications are comparable between the two procedures. Laryngoscope, 129:1731-1736, 2019.
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Affiliation(s)
- Takahiro Kitamura
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka General Medical Center, Osaka, Japan
| | - Yukinori Takenaka
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka General Medical Center, Osaka, Japan
| | - Kazuya Takeda
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka General Medical Center, Osaka, Japan
| | - Ryohei Oya
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka General Medical Center, Osaka, Japan
| | - Naoki Ashida
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka General Medical Center, Osaka, Japan
| | - Kotaro Shimizu
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka General Medical Center, Osaka, Japan
| | - Kazuya Takemura
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka General Medical Center, Osaka, Japan
| | - Yoshifumi Yamamoto
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka General Medical Center, Osaka, Japan
| | - Atsuhiko Uno
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka General Medical Center, Osaka, Japan
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Lou Z, Wei H, Lou Z. Identification of bleeding sites and microwave thermal ablation of posterior epistaxis. Acta Otolaryngol 2019; 139:70-74. [PMID: 30714455 DOI: 10.1080/00016489.2018.1552016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Microwave ablation (MWA) is a relatively new technique which has been used to achieve hemostasis at surgical field. However, few publications have reported MWA for epistaxis. OBJECTIVES Our objectives were to identify the bleeding sites/points in instances of posterior epistaxis and to evaluate the efficacy of MWA for controlling bleeding. MATERIAL AND METHODS Patients with posterior epistaxis who met the inclusion criteria were examined and treated endoscopically using MWA. Recurrent bleeding and complications were evaluated at 1 and 3 months after treatment. RESULTS Of the 71 patients, the bleeding site/point was identified in 67 patients while 4 patients was unknown. Of the 67 patients with known bleeding sites, the olfactory cleft was in 44 patients, the middle meatus in 5 patients, and the inferior meatus in 18 patients. Only the bleeding point was coagulated in the 67 patients while prophylactic MWA in the 4 patients. No side effects or complications (including recurrent bleeding, crusting, nasal discomfort, and nasal septal perforation) were seen at 3-month follow-up. CONCLUSIONS MWA may effectively control posterior epistaxis with a low cost and without complications.
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Affiliation(s)
- Zhengcai Lou
- Department of Otorhinolaryngology, Zhejiang Yiwu Central Hospital of Wenzhou Medical University, Yiwu, Zhejiang, China
| | - Hong Wei
- Department of Ophthalmology, Sichuan University West China Hospital, Sichuan, China
- Department of Ophthalmology, Sichuan University West China Hospital, Chengdu, China
| | - Zihan Lou
- Department of Clinical Medicine, Xinxiang Medical University, Xinxiang City, Xinxiang, China
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Zhou AH, Chung SY, Sylvester MJ, Zaki M, Svider PS, Hsueh WD, Baredes S, Eloy JA. To Pack or Not to Pack: Inpatient Management of Epistaxis in the Elderly. Am J Rhinol Allergy 2018; 32:539-545. [PMID: 30270635 DOI: 10.1177/1945892418801259] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Epistaxis is common in elderly patients, occasionally necessitating hospitalization for the management of severe bleeds. In this study, we aim to explore the impact of nasal packing versus nonpacking interventions (cauterization, embolization, and ligation) on outcomes and complications of epistaxis hospitalization in the elderly. METHODS The 2008-2013 National Inpatient Sample was queried for elderly patients (≥65 years) with a primary diagnosis of epistaxis and accompanying procedure codes for anterior and posterior nasal packing or nonpacking interventions. RESULTS A total of 8449 cases met the inclusion criteria, with 62.4% receiving only nasal packing and 37.6% receiving nonpacking interventions. On average, nonpacking interventions were associated with a 9.9% increase in length of stay and a 54.0% increase in hospital charges. Comorbidity rates did not vary between cohorts, except for diabetes mellitus, which was less common in the nonpacking cohort (26.6% vs 29.0%; P = .014). Nonpacking interventions were associated with an increased rate of blood transfusion (24.5% vs. 21.8%; P = .004), but no significant differences in rates of stroke, blindness, aspiration pneumonia, infectious pneumonia, thromboembolism, urinary/renal complications, pulmonary complications, cardiac complications, or in-hospital mortality. Comparing patients receiving ligation or embolization, no differences in length of stay, complications, or in-hospital mortality were found; however, embolization patients incurred 232.1% greater hospital charges ( P < .001). CONCLUSION Nonpacking interventions in the elderly do not appear to be associated with increased morbidity or mortality when compared to nasal packing only but appear to be associated with increased hospital charges and length of stay. Embolization in the elderly results in greater hospital charges but no change in outcome when compared to ligation.
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Affiliation(s)
- Albert H Zhou
- 1 Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Sei Y Chung
- 1 Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Michael J Sylvester
- 1 Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Michael Zaki
- 1 Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Peter S Svider
- 1 Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Wayne D Hsueh
- 1 Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
- 2 Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Soly Baredes
- 1 Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
- 2 Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Jean Anderson Eloy
- 1 Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
- 2 Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey
- 3 Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
- 4 Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey
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Douglas CM, Tikka T, Broadbent B, Calder N, Montgomery J. Patterns of hospital admission in 54 501 patients with epistaxis over a 20-year period in Scotland, UK. Clin Otolaryngol 2018; 43:1465-1470. [PMID: 29953726 DOI: 10.1111/coa.13178] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 06/22/2018] [Indexed: 01/15/2023]
Abstract
BACKGROUND Epistaxis affects most people over their lifetime. It is the commonest ear, nose and throat emergency. Hospital admission and socio-economic deprivation have been associated with mental health disorders, respiratory illness and with emergency hospital admissions. Low socio-economic status has never previously been associated with epistaxis, a common reason for admission to ear, nose and throat departments throughout the UK. METHODS Demographics from Information Services Division Scotland were analysed over a period of 20 years. This focused on gender, number of admissions, number of bed days, socio-economic deprivation (Scottish Index of Multiple Deprivation) and mortality within 1 year. RESULTS Data from 54 501 patients were assessed. Admission numbers and length of stay have significantly decreased (P < 0.0001). Males are more frequently affected (P = 0.001). Admission numbers were higher for patients in more deprived areas (P < 0.001). Mean duration of stay has decreased by 1 bed day. Surgical intervention of epistaxis has increased significantly (P < 0.001). There is an associated 1-year mortality rate of 9.8% following epistaxis. CONCLUSION There has been a significant decrease in hospital admissions and length of hospital stay in patients admitted with epistaxis over the past 20 years. There is a significant association with deprivation and epistaxis admission.
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Affiliation(s)
- Catriona M Douglas
- Department of Otolaryngology - Head and Neck Surgery, Queen Elizabeth University Hospital, Glasgow, G51 4TF, UK
| | - Theofano Tikka
- Department of Otolaryngology - Head and Neck Surgery, Queen Elizabeth University Hospital, Glasgow, G51 4TF, UK
| | - Benedict Broadbent
- Department of Otolaryngology - Head and Neck Surgery, Queen Elizabeth University Hospital, Glasgow, G51 4TF, UK
| | - Nick Calder
- Department of Otolaryngology - Head and Neck Surgery, Monklands Hospital, Airdrie, ML6 0BG, UK
| | - Jenny Montgomery
- Department of Otolaryngology - Head and Neck Surgery, Queen Elizabeth University Hospital, Glasgow, G51 4TF, UK
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de Bonnecaze G, Gallois Y, Bonneville F, Vergez S, Chaput B, Serrano E. Transnasal Endoscopic Sphenopalatine Artery Ligation Compared With Embolization for Intractable Epistaxis: A Long-term Analysis. Am J Rhinol Allergy 2018; 32:188-193. [PMID: 29676168 DOI: 10.1177/1945892418768584] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Transnasal endoscopic sphenopalatine artery ligation (TESPAL) and selective embolization both provide excellent treatment success rate in the management of intractable epistaxis. Few long-term studies comparing these approaches have been previously published. Recommendations often present these techniques as alternatives, but there is no clear consensus. Objective The purpose of this study was to evaluate and compare the clinical efficacy of sphenopalatine artery ligation versus embolization to control intractable epistaxis. Methods We performed a retrospective study including all patients referred to our tertiary medical center for severe epistaxis and treated by surgical ligation and/or embolization. The patients were classified into 2 groups: those who underwent TESPAL only and those who underwent endovascular embolization only. We evaluate and compare long-term clinical outcomes after surgical ligation or embolization for the control of intractable epistaxis in terms of effectiveness (recurrence rate) and safety (complication rate). Results Forty-one procedures of supraselective embolization and 39 procedures of surgical ligation for intractable epistaxis are reported and analyzed. No significant difference was observed between the groups in terms of demographic factors, comorbidities, or average length of hospital stay. The 1-year success rate was similar (75%) in both groups. Complications (minor and/or major) occurred in 34% cases in the embolization group and in 18% in the surgical group ( P = .09, ns). Bilateral embolization including facial artery was the only treatment method associated with a significant risk of complications ( P = .015). Conclusion TESPAL seems to provide a similar control rate with a decrease in the number of complications compared to selective embolization in the context of intractable epistaxis. Further studies are required.
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Affiliation(s)
- G de Bonnecaze
- 1 Otolaryngology, Head and Neck Surgery Department, University Hospital Rangueil-Larrey, Toulouse, France
| | - Y Gallois
- 1 Otolaryngology, Head and Neck Surgery Department, University Hospital Rangueil-Larrey, Toulouse, France
| | - F Bonneville
- 2 Neuroradiology Department, Pierre-Paul Riquet Hospital, University of Toulouse, Toulouse, France
| | - S Vergez
- 1 Otolaryngology, Head and Neck Surgery Department, University Hospital Rangueil-Larrey, Toulouse, France
| | - B Chaput
- 3 Plastic and Aesthetic Surgery Department, University Hospital Rangueil-Larrey, Toulouse, France
| | - E Serrano
- 1 Otolaryngology, Head and Neck Surgery Department, University Hospital Rangueil-Larrey, Toulouse, France
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Treatment of sphenopalatine artery bleeding. Eur Arch Otorhinolaryngol 2017; 275:649-651. [PMID: 28993939 DOI: 10.1007/s00405-017-4761-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 09/26/2017] [Indexed: 10/18/2022]
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Endoscopic sphenopalatine artery ligation for acute idiopathic epistaxis. Do anatomical variation and a limited evidence base raise questions regarding its place in management? The Journal of Laryngology & Otology 2017; 131:290-297. [PMID: 28179040 DOI: 10.1017/s0022215117000214] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Endoscopic sphenopalatine artery ligation is widely accepted as effective and safe for acute spontaneous epistaxis that is unresponsive to conservative management. As with many new procedures, it has been progressively adopted as common practice, despite a limited evidence base for its efficacy. Early reviews called for comparative trials to support its adoption, but subsequent literature largely consists of case series and narrative reviews. These have attempted to derive an algorithm to establish its place in management, but consensus is still lacking. Intuitively, although there are theoretical objections, an operation regarded as relatively simple, fast and safe hardly seems to demand high-level evidence of efficacy. Rhinologists may be influenced by years of personal experience and success with the technique. However, estimates of the effect size and the added contribution to traditional surgical management are lacking. If the procedure could be shown to dramatically influence outcome, it should be standard practice and indispensable for all patients requiring operative intervention. OBJECTIVES This paper systematically examined the literature, appraising the anatomical basis for such an approach and evidence for its efficacy. It questions whether any units unable to consistently offer endoscopic sphenopalatine artery ligation should be undertaking surgical management of acute epistaxis.
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Odat H, Al-Qudah M. Endoscopic monopolar cauterization of the sphenopalatine artery: a single surgeons experience. Ann Saudi Med 2016; 36:422-426. [PMID: 27920415 PMCID: PMC6074210 DOI: 10.5144/0256-4947.2016.422] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Epistaxis is one of the most common otolaryngology emergency conditions, and is usually treated conservatively by different types of nasal packs. A limited number of patients continue to bleed even with tightly fitted anterior and posterior packs in the nose. Such intractable epistaxis is managed by surgery or embolization. OBJECTIVES We reviewed the use and outcomes of endoscopic suction monopolar cauterization of the sphenopalatine artery. DESIGN Retrospective study. SETTING Tertiary academic center. PATIENTS AND METHODS Subjects who underwent consecutive monopolar sphenopalatine artery ligation for intractable epistaxis performed by a senior author from August 2010 to December 2014. MAIN OUTCOME MEASURE(S) Successful management of refractory epistaxis. RESULTS In 15 subjects (mean age 45 years; 10 men and 5 women) idiopathic epistaxis was the most common indication for surgery. Six patients had hypertension and three were on anticoagulation. One patient required bilateral cauterization and another had anterior ethmoid artery cauterization. The average operative time was 57 minutes. There was no major intra- or postoperative complications. Two patients underwent endoscopic sinus surgery to treat pathologies that were found during the procedure. All patients had healthy nasal and sinus mucosa during the follow-up period (average 17 months, range 1-70 months), and none suffered recurrent epistaxis. CONCLUSIONS Endoscopic monopolar cauterization of sphenopalatine artery is safe and effective for management of refractory epistaxis with minimal complications. It should be considered earlier in the algo- rithmic treatment of intractable epistaxis. LIMITATIONS Retrospective study, small number of patients, and no controls.
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Affiliation(s)
- Haitham Odat
- Haitham Odat, Department of Special Surgery,, Jordan University of Science and Technology,, Irbid 22110, Jordan, T: +962798201825, , ORCID: http://orcid.org/0000-0002-5148-7600
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Vosler PS, Kass JI, Wang EW, Snyderman CH. Successful Implementation of a Clinical Care Pathway for Management of Epistaxis at a Tertiary Care Center. Otolaryngol Head Neck Surg 2016; 155:879-885. [PMID: 27352889 DOI: 10.1177/0194599816657045] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 06/08/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE We compare the management of patients with severe epistaxis before and after the implementation a clinical care pathway (CCP) to standardize care, minimize hospital stay, and decrease cost. STUDY DESIGN Single prospective analysis with historical control. SETTING Tertiary academic hospital. SUBJECTS AND METHODS Patients treated for epistaxis between October 2012 to December 2013 were compared with a prospective analysis of patients treated for severe epistaxis after implementation of a CCP from June 2014 to February 2015. Severe epistaxis was defined as nasal bleeding not able to be controlled with local pressure, topical vasoconstrictors, or simple anterior packing. RESULTS Severe epistaxis was similar in the pre- and post-CCP cohorts: 24.7% (n = 42) vs 18.9% (n = 22), respectively. Implementation of early sphenopalatine artery ligation resulted in decreased number of days packed (3.2 ± 1.6 to 1.4 ± 1.6; P = .001), decreased hospital stay (5.2 ± 3.9 to 2.1 ± 1.3 days; P < .001), an increased percentage of sphenopalatine artery ligations (31.0% vs 54.5%; P = .035), admission to an appropriate hospital location with access to key resources (41.7% vs 83.3%; P = .007), and decreased overall cost of hospitalization by 66% ($9435 saved). No patients received embolization after the CCP was implemented. CONCLUSIONS Implementation of a CCP decreased hospital stay and days of packing, facilitated definitive care in patients with severe epistaxis, improved patient safety, and decreased cost. The results of this study can serve as a model for the management of severe epistaxis and for future quality improvement measures.
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Affiliation(s)
- Peter S Vosler
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jason I Kass
- Department of Otolaryngology-Head and Neck Surgery, Boston University, Boston, Massachusetts, USA
| | - Eric W Wang
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Carl H Snyderman
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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İsmi O, Vayisoğlu Y, Özcan C, Görür K, Ünal M. Endoscopic Sphenopalatine Artery Ligation in Posterior Epistaxis: Retrospective Analysis of 30 Patients. Turk Arch Otorhinolaryngol 2016; 54:47-52. [PMID: 29392016 DOI: 10.5152/tao.2016.1713] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Accepted: 07/13/2016] [Indexed: 11/22/2022] Open
Abstract
Objective Although posterior epistaxis is rarely seen, it is an important medical problem that both decreases the quality of life of the patient and causes difficulties in the management for otorhinolaryngologists. In this study, we aimed to present the results of 30 patients who underwent transnasal endoscopic sphenopalatine artery ligation (TESPAL) for posterior epistaxis in our department. Methods The records of 30 patients who underwent TESPAL from January 2014 to April 2016 were analyzed retrospectively, and the relationship between perioperative factors and need for revision surgery was assessed. Results The success rate of TESPAL in posterior epistaxis was 90%. There was no relationship between surgical failure and antiaggregant use (p=0.224), anticoagulant use (p=0.534), hypertension (p=0.564), previous nasal surgery (p=0.279), and bilateral TESPAL application (p=0.279). TESPAL was seen to be effective in cases with Osler-Weber-Rendu disease, pregnancy, and uncontrollable epistaxis after rhinoplasty surgery. Mortality was seen in one of our patients not related to endoscopic ligation in the follow-up period. Conclusion TESPAL is an effective method in the treatment of posterior epistaxis. Hypertension, antiaggregant or anticoagulant use, bilateral sphenopalatine artery ligation, and previous nasal surgery do not seem to be factors leading to surgical failure.
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Affiliation(s)
- Onur İsmi
- Department of Otorhinolaryngology, Mersin University School of Medicine, Mersin, Turkey
| | - Yusuf Vayisoğlu
- Department of Otorhinolaryngology, Mersin University School of Medicine, Mersin, Turkey
| | - Cengiz Özcan
- Department of Otorhinolaryngology, Mersin University School of Medicine, Mersin, Turkey
| | - Kemal Görür
- Department of Otorhinolaryngology, Mersin University School of Medicine, Mersin, Turkey
| | - Murat Ünal
- Department of Otorhinolaryngology, Mersin University School of Medicine, Mersin, Turkey
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