ABSTRACT
Resumen Antecedentes Los casos de epistaxis posterior representan alrededor del 10 al 20% de las epistaxis. El tratamiento convencional para este tipo de padecimientos son los taponamientos nasales. El abordaje quirúrgico (cauterización y/o clipaje) está indicado cuando existe falla del tratamiento médico convencional; sin embargo, en la actualidad, se considera como primera opción. Material y métodos Se revisaron todos los casos de epistaxis posterior tratados en el Hospital Español de México de enero de 2007 a enero de 2017. Se realizó estadística descriptiva e inferencial para comparar al grupo conservador (taponamiento nasal) versus el grupo quirúrgico (clipaje). Resultados Se revisaron 242 expedientes; de ellos, se excluyeron 108. Se incluyeron 134 pacientes: 96 correspondieron al grupo quirúrgico y 38 al conservador. El 60.20% perteneció al género masculino y el 39.80% al femenino. La media para la edad fue de 60 años. El grupo quirúrgico (3.4 ± 1.9 días) requirió menos días de estancia hospitalaria en comparación con el conservador (4.8 ± 3.0 días), p < 0.01. Los pacientes con una epistaxis del lado derecho en el grupo quirúrgico tuvieron un mayor tiempo quirúrgico (p = 0.001) y más días de estancia hospitalaria (p = 0.006). Conclusiones La epistaxis sucede en la mayoría de los casos de forma idiopática; es frecuente en hombres mayores de 60 años con enfermedades cardiopulmonares, sin conocerse de forma precisa su fisiopatología. La epistaxis derecha tratada quirúrgicamente resulta tener más morbilidad. El abordaje quirúrgico es seguro, eficaz y acorta los días de estancia hospitalaria en comparación con el tratamiento conservador.
Abstract Background The cases of posterior epistaxis represent approximately 10 to 20% of all epistaxis. The conventional treatment for this type of ailment is nasal packing. A surgical approach (cauterization and/ or clipping) is indicated when there is a failure of the conventional medical treatment; however, it is currently considered as the first option. Material and methods All the epistaxis cases treated at the Hospital Español de México from January 2007 to January 2017 were reviewed. Descriptive and inferential statistics were used to compare the conservative group (nasal packing) versus the surgical one (clipping). Results 242 dossiers were reviewed, of which 108 were excluded. 134 patients were included: 96 belonged to the surgical group and 38 to the conservative one. 60.20% were male and 39.80% were female. The mean age was 60 years. The surgical group (3.4 ± 1.9 days) required fewer days of hospital stay compared to the conservative group (4.8 ± 3.0 days), p < 0.01. Patients with right-sided epistaxis in the surgical group had a longer surgical time (p = 0.001) and more days of hospital stay (p = 0.006). Conclusions Epistaxis occurs in most cases idiopathically, often in men over 60 years with cardiopulmonary diseases, without a precise knowledge of its physiopathology. Right epistaxis treated surgically results in more morbidity. The surgical approach is safe, effective and shortens the days of hospital stay compared to the conservative treatment.
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Objective To preliminarily discuss the safety and effectiveness of embolization of dural arteriovenous fistula of anterior cranial fossa via sphenopalatine artery. Methods From January 2002 to June 2017,the clinical data of 7 patients with dural arteriovenous fistula of anterior cranial fossa embolized via sphenopalatine artery at Department of Neurosurgery,Xuanwu Hospital,Capital Medical University were analyzed retrospectively.There were 6 men and 1 woman,their mean age was 60.4 ± 3.6 years.One patient had subarachnoid hemorrhage with hematoma,6 had non-specific symptoms. The technical methods and complications via sphenopalatine artery embolization were analyzed.The occlusion of the proximal drainage vein with the embolization agent was used as the standard for successful embolization.They were all clinically followed up at 6 months after procedure. Results (1)Five patients selected sphenopalatine artery as the preferred treatment.After embolization failed in other treatment approaches,2 patients were re-embolized via sphenopalatine artery. Five lesions were successfully embolized via sphenopalatine artery,including the sphenopalatine artery as the preferred treatment approach in 4 cases,the sphenopalatine artery as a remedial embolization approach after the failure of other arterial approaches in 1 case.Transsphenoidal artery failed to occlude the lesions in 2 cases,including successful embolization of other blood supply artery in 1 case during the operation,and postoperative angiography revealed that the lesion was almost completely occluded in the other 1.All patients recovered well without complications after procedure.(2)All patients were followed up for 6 months after procedure.The patients did not have blurred vision and other new neurological disorders, and they did not have new intracranial hemorrhage and nasal symptoms.Two of them underwent angiographic follow-up at admission.The immediate angiography in 1 patient showed that his lesion completely disappeared,At 6 months after operation,angiography revealed that the lesion was recurrence-free. The immediate angiography in 1 patient showed that his lesion nearly completely disappeared.At 4 months after operation, angiography revealed that the lesion disappeared completely. Conclusions Embolization of dural arteriovenous fistulas of anterior cranial fossa via sphenopalatine artery is a feasible,safe and effective treatment. It is also the treatment option after other poor arterial approach or failure of other arterial approach.
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Sphenopalatine artery ligation (SPL) is a surgical remedy for severe epistaxis. This procedure requires extensive knowledge of the various anatomical variants. Its topographical anatomy varies and reliable landmark such as the crista ethmoidalis may be absent. These variations are crucial and they dictate the outcome of the surgery. We present a peculiar case of a postero-superiorly located variant of the sphenopalatine foramen and artery with an absent crista ethmoidalis. The sphenopalatine foramen was found superiorly at the superior meatus beyond the horizontal part of the lamella of the superior concha. Only one trunk was seen exiting the sphenopalatine foramen. The sphenopalatine foramen was measured from the anterior part of the nose. It was 69mm from the nasal sill and 54mm limen nasi.
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La epistaxis posterior es una de las urgencias más frecuente en la Otorrinolaringología. A pesar de esto no hay lineamientos claros entre los especialistas para su manejo. En este trabajo revisamos nuestra experiencia en 67 pacientes con diagnóstico de epistaxis severa que ingresaron por la guardia del Hospital Universitario ¨José de San Martín¨, entre el período de enero - septiembre de 2014 y comparándola con la literatura mundial con el objetivo de postular un algoritmo de tratamiento de esta enfermedad. A 66 de los 67 pacientes se les realizó taponaje anteroposterior (TAP) con diferentes métodos y 1 de los 67 fue directamente a cirugía endoscó- pica rinosinusal (CERS)...
Posterior epistaxis is one of the most common otolaryngology emergencies. Despite this, there are no clear guidelines among specialists for its management. In this paper, we review our experience in 67 patients with diagnosis of severe epistaxis who were evaluated on the emergency room of the University Hospital Jose de San Martin between January to September 2014. We compared our experience with the world literature in order to apply an algorithm treatment of this disease. 66 of 67 patients underwent posterior nasal packing (PNP)...
A epistaxe posterior é uma das emergências otorrinolaringológicas mais comuns. Apesar disso, não há um claro consenso entre os especialistas sobre seu procedimento. Neste artigo, apresentamos nossa experiência com 67 pacientes com diagnóstico de epistaxe grave atendidos pelo plantão do Hospital Universitário Jose de San Martin entre o período de janeiro a setembro de 2014 e comparamos com a literatura mundial, a fim de determinar um algoritmo de tratamento desta doença. 66 dos 67 casos foram submetidos a tamponamento ântero-posterior (TAP) com diferentes métodos e 1 foi diretamente encaminhado para cirurgia endoscópica rinossinusal (CERS). Destes 67 pacientes, 31 tiveram inicialmente escolhido o TAP como tratamento definitivo e, para os 36 restantes, CERS...
Subject(s)
Male , Female , Humans , Adult , Young Adult , Middle Aged , Aged , Aged, 80 and over , Epistaxis/surgery , Epistaxis/therapy , Algorithms , Endotamponade , Hemorrhage/therapy , Natural Orifice Endoscopic SurgeryABSTRACT
Introducción: La epistaxis corresponde al motivo de consulta de urgencia más frecuente en otorrinolaringología. Su etiología es multifactorial, predominantemente de causa traumática. Una alternativa de manejo quirúrgico en los casos de epistaxis significativa es la cauterización o ligadura endoscópica de la arteria esfenopalatina (AEP). Objetivos: Este estudio pretende revisar la experiencia del Hospital Clínico de la Universidad de Chile en el manejo endoscópico de pacientes con epistaxis posterior. Material y método: Se revisaron los registros quirúrgicos del servicio entre los años 2007y 2011 considerando todos los pacientes que fueron tratados por epistaxis posterior mediante cirugía endoscópica nasal. Resultados: Se revisó un total de 23 casos. La edad promedio de los pacientes fue 52±18 años. Sesenta por ciento presentaba el antecedente de hipertensión arterial en tratamiento. Se realizó ligadura con clips más electrocauterización de AEP en 52,1% de los casos, ligadura con clips de AEP en 26,2%%, y electrocauterización de AEP en 21,7%% de los casos. Discusión y conclusiones: El manejo endoscópico de las epistaxis posteriores es una técnica sencilla y reproducible, constituyendo una herramienta terapéutica segura y eficaz para estos pacientes.
Introduction: Epistaxis is by far the most common emergency complaint in otolaryngology. Its etiology is multifactorial, predominantly by traumatic causes. An alternative in surgical management of significant epistaxis cases, is the endoscopic cauterization or ligature of the sphenopalatine artery (SPA). Aim: This study aims to review the experience of the Hospital Clínico de la Universidad de Chile in the endoscopic management of patients with posterior epistaxis. Material and methods: The surgical records have been reviewed between the years 2007and 2011, considering all patients who were treated for posterior epistaxis, by endoscopic nasal surgery. Results: A total of 23 cases were reviewed. The average age of patients was 52 ± 18 years. 60% of patients had a history of hypertension in treatment. Clip ligature with electrocauterization of the SPA was performed in 52.1% of cases, clip ligature of the SPA in 26.2%%, and isolated electrocauterization of the SPA in 21.7%% of cases. Discussion and conclusions: Endoscopic treatment of posterior epistaxis is a simple and reproducible technique, being a safe and effective therapeutic tool for these patients.
Subject(s)
Humans , Epistaxis/therapy , Endoscopy/methods , Epistaxis/surgery , Retrospective StudiesABSTRACT
OBJECTIVE To demonstrate the bleeding sites and the major blood supply in patients with hidden epistaxis. METHODS The clinical data of 106 patients with hidden epistaxis were studied retrospectively. The bleeding sites and hemorrhagic focus was not found by routine anterior nasoscope examination was defined as hidden epistaxis. The bleeding sites were located and the bleeding was stopped under nasal endoscope. RESULTS The hemorrhagic foci were found in the following sites: 55.7%(59/106)at the top of inferior meatus, 33.0% (35/106)middle turbinate and the top of middle meatus, 9.4%(10/106)olfactory cleft and the nasal septum, and 1.9%(2/106)unknown. The bleeding sites were found and the bleeding was stopped with radiofrequency under nasal endoscope in 104 cases. Bleeding was stopped by treatment once in 102 cases(96.2%)and treatment twice in 2 cases(1.9%). All the patients were followed up for over one month without recurrence and the cure rate was 98.1%. Bleeding sites were not found in 2 cases because of heavy damage of the nasal mucosa. CONCLUSION ①The majority of hidden epistaxis is supplied by the sphenopalatine artery. ②To find the bleeding sites and stop the bleeding in hidden epistaxis patients under nasal endoscope using radiofrequency is effective, minimally invasive and worth of clinic application extensively.
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BACKGROUND AND OBJECTIVES: With the recent development of endoscopic nasal surgery, endoscopic sphenopalatine artery ligation allows for secure control of posterior epistaxis with considerably low recurrence and complications. Surgical approaches to the sphenopalatine foramen to ligate the sphenopalatine artery are transantral, intranasal, and transseptal. However, the procedures have considerable limitations. Therefore, we have revised the transturbinal approach, which was described by Togawa for intranasal vidian neurectomy in 1977, to ligate the sphenopalatine artery in two patients of intractable posterior epistaxis, and describe our technique of the trans-inferior turbinate approach for endoscopic sphenopalatine artery ligation. SURGICAL TECHNIQUE: A longitudinal incision is made along the lower border of the inferior turbinate, and the mucoperiosteal flaps are developed to the lateral nasal wall. The posterior two-thirds of the inferior turbinate bone is removed from the lateral nasal wall. The posterior lateral nasal artery on the upper flap is positively identified, and followed to the posterior end of the middle turbinate bone. The sphenopalatine foramen can be localized after removing the posterior end of the middle turbinate bone, and the sphenopalatine artery is ligated with hemoclips or divided with bipolar electrocautery. RESULTS: With the trans-inferior turbinate approach, it was possible to identify and ligate the sphenopalatine artery and its branches in the sphenopalatine foramen with no immediate or delayed complications. CONCLUSION: The trans-inferior turbinate approach provides unobscured surgical access to the posterior nasal cavity, and enough working space for endoscopic manipulation. The posterior lateral nasal artery is a reliable surgical landmark leading to the sphenopalatine foramen.
Subject(s)
Humans , Arteries , Electrocoagulation , Epistaxis , Ligation , Nasal Cavity , Nasal Surgical Procedures , Recurrence , TurbinatesABSTRACT
Objective:To provide anatomic data for accurately localizing aperture of sphenoidal sinus without injurying sphenopalatine arteries in endoscopic transsphenoidal sella surgery.Methods: The anterior walls of spheroid sinus were observed and measured(layout,position,external diameter,distances to other structures of interest) with a vernier caliper and an angle gauge on 15 adult cadavers.Results: The distances from the root of columella nasi to the inforior pole of sphenoidal sinus aperture and the sphenopalatine foramen were(60.40?3.21,58.10-72.76) mm and(62.14?1.93,59.50-73.40) mm,respectively.The distance from the inforior pole sphenoidal sinus aperture to the sphenopalatine foramen was(12.20?1.10,8.10-16.35) mm.The diameter of the sphenopalatine artery was(1.99?0.13,1.50-2.80) mm.The distances from the inforior pole of sphenoidal sinus aperture to the superior and inferior posterior artery of nasal septum were(3.49?0.24,2.78-5.20) mm and(6.42?1.08,(4.30-8.50)) mm,respectively.Conclusion: Aperture of sphenoidal sinus is an important marker in endosopic transsphenoidal sella surgery.The anterior wall of sphenoid sinus should be opened from the inforior pole of sphenoidal sinus aperture to avoid injurying sphenopalatine artery.