Epistaxis

Epistaxis caused by hemangioma of the inferior turbinate

September 30, 2006     Joseph P. Mirante, MD; Dewey A. Christmas, MD; Eiji Yanagisawa, MD
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An alternative to a postnasal pack for the arrest of perioperative hemorrhage following curettage adenoidectomy

December 1, 2005     Julian Savage, MRCS; Albert Pace-Balzan, FRCS
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Abstract
Controlling bleeding with standard postnasal packing following curettage adenoidectomy is only occasionally warranted. Children find the packing experience unpleasant, and removal of the packing usually requires general anesthesia. We describe a simple technique for packing the nasopharynx with bilateral nasal tampons via an anterior approach. The tampons are much easier to insert than standard packing, they are well tolerated while in place, and they can be easily removed with perhaps only some light sedation rather than general anesthesia.

Brown tumor of the facial bones: Case report and literature review

June 30, 2005     Marcus M. Lessa, PhD; Flavio A. Sakae, PhD; Robinson K. Tsuji, PhD; Bernardo C. Ara├║jo Filho, PhD; Richard L. Voegels, MD; Ossamu Butugan, MD
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Abstract
Brown tumor, an uncommon focal giant-cell lesion, arises as a direct result of the effect of parathyroid hormone on bone tissue in patients with hyperparathyroidism. The initial treatment involves the correction of hyperparathyroidism, which usually leads to tumor regression. We report a case of brown tumor of the right nasal fossa in a 71-year-old woman. The tumor had caused nasal obstruction and epistaxis. Laboratory evaluation revealed that the patient had primary hyperparathyroidism. Anatomicopathologic investigation revealed the presence of a giant-cell tumor. We performed a partial parathyroidectomy, but the tumor in the right nasal fossa failed to regress. One year later, we performed surgical resection of the lesion. The patient recovered uneventfully, and she remained asymptomatic and recurrence-free at the 1-year follow-up. Facial lesions with histologic features of a giant-cell tumor should be evaluated from a systemic standpoint. Hyperparathyroidism should always be investigated by laboratory tests because most affected patients are asymptomatic. Surgical resection of a brown tumor should be considered if the mass does not regress after correction of the inciting hyperparathyroidism or if the patient is highly symptomatic.

Endoscopic ligation of the sphenopalatine artery as a primary management of severe posterior epistaxis in patients with coagulopathy

April 30, 2005     Anand G. Shah, MD; Robert J. Stachler, MD; John H. Krouse, MD, PhD
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Abstract

We describe our experience with endoscopic ligation of the sphenopalatine artery in the treatment of severe posterior epistaxis in 2 patients with coagulopathy. Conservative treatment had failed in both cases. The key elements of this procedure are the identification of the branches of the sphenopalatine artery via an endoscopic endonasal approach and the application of two titanium clips under direct vision. This procedure was successful in both patients, and we recommend it in selected cases.

The effect of silver nitrate on nasal septal cartilage

January 1, 2005     Simon Lloyd, BSc (Hons), MRCS; John Almeyda, FRCS (ORL); Riccardo Di Cuffa, MRCS; Ketan Shah, FRCPath
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Abstract
Epistaxis from the anterior septum is frequently treated with a topical application of silver nitrate, which cauterizes the bleeding vessel. However, this treatment causes a septal perforation in a small percentage of patients. We report our study of the histologic effect of topical silver nitrate on samples of septal tissue obtained from 11 patients. We found that 30 seconds of exposure allowed silver nitrate to penetrate to a depth of approximately 1 mm. Longer exposure (45 and 60 sec) resulted in no significant additional penetration. Similarly, the amount of silver nitrate deposition into the chondrocytic lacunae did not vary significantly with the length of exposure. On the other hand, the depth of deposition into the extracellular matrix was positively associated with the duration of exposure. We found no direct evidence that silver nitrate exerted any damaging effect on septal cartilage. Instead, the development of septal perforations in patients who receive topical silver nitrate may be attributable to necrosis of the septal cartilage following damage to the overlying perichondrium, from which it derives its blood supply.

Sinonasal tract glomangiopericytoma (hemangiopericytoma)

December 1, 2004     Lester D.R. Thompson, MD
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Selective Surgicel packing for the treatment of posterior epistaxis

August 31, 2004     R.K. Bhatnagar, FRCS; Sandeep Berry, MRCS
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Abstract
Rod lens endoscopes provide residents in otolaryngology a means of more accurately identifying the site of bleeding and, when possible, cauterizing the bleeding vessel. Identification of a posterior bleeding point is often difficult and sometimes impossible. Intranasal manipulation for electrocautery is painful, may require general anesthesia, and is associated with complications. We describe a pilot study designed to evaluate selectively packing the bleeding site with Surgicel (oxidized cellulose) to control the hemorrhage without packing the nasal cavity and to reduce patient morbidity and length of stay in the hospital. We describe the technique and present the results of treating 8 patients admitted with acute posterior epistaxis over a 10-month period in 1995-1996.

Extramedullary hematopoiesis occurring as a nasal polyp in a man with a myeloproliferative disorder

April 1, 2004     Lawrence V. Brennan, MD; Thomas Mayer, MD; James Devitt, MD
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