Epistaxis surgery: Difference between revisions
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{{CMG}}; {{AE}} [[User:Amir Bagheri|Amir Behzad Bagheri, M.D.]] | {{CMG}}; {{AE}} [[User:Amir Bagheri|Amir Behzad Bagheri, M.D.]] | ||
==Overview== | ==Overview== | ||
[[Surgery]] is not the [[first-line treatment]] option for patients with [[epistaxis]]. [[Surgery]] is usually reserved for patients with either heavy [[active bleeding]], recurrent [[epistaxis]] | [[Surgery]] is not the [[first-line treatment]] option for patients with [[epistaxis]]. [[Surgery]] is usually reserved for patients with either heavy [[active bleeding]], recurrent [[epistaxis]] or non-compliant [[Epistaxis medical therapy|medical therapy]]. | ||
== Surgery == | == Surgery == | ||
[[Surgery]] is not the [[first-line treatment]] option for patients with [[epistaxis]]. [[Surgery]] is usually reserved for patients with either heavy [[active bleeding]], recurrent [[epistaxis]] | [[Surgery]] is not the [[first-line treatment]] option for patients with [[epistaxis]]. [[Surgery]] is usually reserved for patients with either heavy [[active bleeding]], recurrent [[epistaxis]] or non-compliant [[Epistaxis medical therapy|medical therapy]].<ref name="TunkelAnne2020">{{cite journal|last1=Tunkel|first1=David E.|last2=Anne|first2=Samantha|last3=Payne|first3=Spencer C.|last4=Ishman|first4=Stacey L.|last5=Rosenfeld|first5=Richard M.|last6=Abramson|first6=Peter J.|last7=Alikhaani|first7=Jacqueline D.|last8=Benoit|first8=Margo McKenna|last9=Bercovitz|first9=Rachel S.|last10=Brown|first10=Michael D.|last11=Chernobilsky|first11=Boris|last12=Feldstein|first12=David A.|last13=Hackell|first13=Jesse M.|last14=Holbrook|first14=Eric H.|last15=Holdsworth|first15=Sarah M.|last16=Lin|first16=Kenneth W.|last17=Lind|first17=Meredith Merz|last18=Poetker|first18=David M.|last19=Riley|first19=Charles A.|last20=Schneider|first20=John S.|last21=Seidman|first21=Michael D.|last22=Vadlamudi|first22=Venu|last23=Valdez|first23=Tulio A.|last24=Nnacheta|first24=Lorraine C.|last25=Monjur|first25=Taskin M.|title=Clinical Practice Guideline: Nosebleed (Epistaxis)|journal=Otolaryngology–Head and Neck Surgery|volume=162|issue=1_suppl|year=2020|pages=S1–S38|issn=0194-5998|doi=10.1177/0194599819890327}}</ref> <ref name="KrulewitzFix2019">{{cite journal|last1=Krulewitz|first1=Neil Alexander|last2=Fix|first2=Megan Leigh|title=Epistaxis|journal=Emergency Medicine Clinics of North America|volume=37|issue=1|year=2019|pages=29–39|issn=07338627|doi=10.1016/j.emc.2018.09.005}}</ref> | ||
* '''Nasal [[cautery]]''' | * '''Nasal [[cautery]]''' | ||
**Before cautery [[anesthesia]] [[bleeding]] site | **Before cautery [[anesthesia]] [[bleeding]] site | ||
**Restrict nasal [[cautery]] to the site of bleeding | **Restrict nasal [[cautery]] to the site of bleeding | ||
**Nasal [[cautery]] is the most | **Nasal [[cautery]] is the most typical surgery procedure to stop nasal [[bleeding]]. | ||
**Surgical nasal [[cautery]] has two options : | **Surgical nasal [[cautery]] has two options : | ||
***[[Electrical]] [[Cauterization|cautery]] | ***[[Electrical]] [[Cauterization|cautery]] | ||
| Line 21: | Line 21: | ||
*[[Embolization]] and [[surgical]] [[arterial]] [[ligation]]: | *[[Embolization]] and [[surgical]] [[arterial]] [[ligation]]: | ||
**Embolization and [[surgical]] [[arterial]] [[ligation]] are the most effective procedures. | **Embolization and [[surgical]] [[arterial]] [[ligation]] are the most effective procedures. | ||
** | **If these procedures do not stop [[bleeding]], [[embolization]] of [[bleeding]] [[artery]] and [[surgical]] [[arterial]] [[ligation]] are the next best options. | ||
<br /> | <br /> | ||
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== Indications == | == Indications == | ||
*[[Surgery]] is not the [[first-line treatment]] option for patients with [[epistaxis]]. In active [[bleeding]] nasal compression is the first line to stop [[bleeding]]. | *[[Surgery]] is not the [[first-line treatment]] option for patients with [[epistaxis]]. In active [[bleeding]], nasal compression is the first line option to stop [[bleeding]]. If nasal compression and [[Epistaxis medical therapy|medical therapies]] not stop [[bleeding]], surgery options are available to control bleeding.<ref name="TunkelAnne2020" /> | ||
* | * If these procedures do not stop [[bleeding]], [[embolization]] of [[bleeding]] [[artery]] and [[surgical]] [[arterial]] [[ligation]] are the next best options. | ||
== Contraindications == | == Contraindications == | ||
* Endovascular embolization of the anterior and/or posterior [[ethmoid]] [[arteries]] is [[contraindicated]], as they originate from the [[ophthalmic artery]] there is a risk of [[blindness]] with this procedure.<ref name="TunkelAnne2020" /><ref name="Araujo FilhoPinheiro-Neto2011">{{cite journal|last1=Araujo Filho|first1=Bernardo Cunha|last2=Pinheiro-Neto|first2=Carlos Diógenes|last3=Ramos|first3=Henrique Faria|last4=Voegels|first4=Richard Louis|last5=Sennes|first5=Luiz Ubirajara|title=Ligadura endoscópica da artéria etmoidal anterior: estudo de dissecção em cadáveres|journal=Brazilian Journal of Otorhinolaryngology|volume=77|issue=1|year=2011|pages=33–38|issn=1808-8686|doi=10.1590/S1808-86942011000100006}}</ref> | * Endovascular embolization of the anterior and/or posterior [[ethmoid]] [[arteries]] is [[contraindicated]], as they originate from the [[ophthalmic artery]]. Therefore, there is a risk of [[blindness]] with this procedure.<ref name="TunkelAnne2020" /><ref name="Araujo FilhoPinheiro-Neto2011">{{cite journal|last1=Araujo Filho|first1=Bernardo Cunha|last2=Pinheiro-Neto|first2=Carlos Diógenes|last3=Ramos|first3=Henrique Faria|last4=Voegels|first4=Richard Louis|last5=Sennes|first5=Luiz Ubirajara|title=Ligadura endoscópica da artéria etmoidal anterior: estudo de dissecção em cadáveres|journal=Brazilian Journal of Otorhinolaryngology|volume=77|issue=1|year=2011|pages=33–38|issn=1808-8686|doi=10.1590/S1808-86942011000100006}}</ref> | ||
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! colspan="2" align="center" style="background:#DCDCDC;" + |This page developed and modified according to Epistaxis of Emergency Medicine Clinics of North America and Clinical Practice Nosebleed (Epistaxis) Guideline. This guideline was published in the January 2020 issue of the American Academy of Otolaryngology-Head and Neck Surgery. | ! colspan="2" align="center" style="background:#DCDCDC;" + |This page developed and modified according to Epistaxis of Emergency Medicine Clinics of North America and Clinical Practice Nosebleed (Epistaxis) Guideline. This guideline was published in the January 2020 issue of the American Academy of Otolaryngology-Head and Neck Surgery. | ||
|} | |} | ||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
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{{WikiDoc Sources}} | {{WikiDoc Sources}} | ||
[[Category: | [[Category:Up-To-Date]] | ||
[[Category:Otolaryngology]] | [[Category:Otolaryngology]] | ||
[[Category:Rhinology]] | [[Category:Rhinology]] | ||
[[Category:First aid]] | [[Category:First aid]] | ||
[[Category:Injuries]] | [[Category:Injuries]] | ||
Latest revision as of 16:36, 13 January 2021
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Epistaxis Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Epistaxis surgery On the Web |
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American Roentgen Ray Society Images of Epistaxis surgery |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Amir Behzad Bagheri, M.D.
Overview
Surgery is not the first-line treatment option for patients with epistaxis. Surgery is usually reserved for patients with either heavy active bleeding, recurrent epistaxis or non-compliant medical therapy.
Surgery
Surgery is not the first-line treatment option for patients with epistaxis. Surgery is usually reserved for patients with either heavy active bleeding, recurrent epistaxis or non-compliant medical therapy.[1] [2]
- Nasal cautery
- Nasal balloon or Foley catheter:
- A nasal balloon or Foley catheter is a good options to control bleeding specially in posterior-epistaxis.
- Embolization and surgical arterial ligation:
Indications
- Surgery is not the first-line treatment option for patients with epistaxis. In active bleeding, nasal compression is the first line option to stop bleeding. If nasal compression and medical therapies not stop bleeding, surgery options are available to control bleeding.[1]
- If these procedures do not stop bleeding, embolization of bleeding artery and surgical arterial ligation are the next best options.
Contraindications
- Endovascular embolization of the anterior and/or posterior ethmoid arteries is contraindicated, as they originate from the ophthalmic artery. Therefore, there is a risk of blindness with this procedure.[1][3]
| This page developed and modified according to Epistaxis of Emergency Medicine Clinics of North America and Clinical Practice Nosebleed (Epistaxis) Guideline. This guideline was published in the January 2020 issue of the American Academy of Otolaryngology-Head and Neck Surgery. |
|---|
References
- ↑ 1.0 1.1 1.2 Tunkel, David E.; Anne, Samantha; Payne, Spencer C.; Ishman, Stacey L.; Rosenfeld, Richard M.; Abramson, Peter J.; Alikhaani, Jacqueline D.; Benoit, Margo McKenna; Bercovitz, Rachel S.; Brown, Michael D.; Chernobilsky, Boris; Feldstein, David A.; Hackell, Jesse M.; Holbrook, Eric H.; Holdsworth, Sarah M.; Lin, Kenneth W.; Lind, Meredith Merz; Poetker, David M.; Riley, Charles A.; Schneider, John S.; Seidman, Michael D.; Vadlamudi, Venu; Valdez, Tulio A.; Nnacheta, Lorraine C.; Monjur, Taskin M. (2020). "Clinical Practice Guideline: Nosebleed (Epistaxis)". Otolaryngology–Head and Neck Surgery. 162 (1_suppl): S1–S38. doi:10.1177/0194599819890327. ISSN 0194-5998.
- ↑ Krulewitz, Neil Alexander; Fix, Megan Leigh (2019). "Epistaxis". Emergency Medicine Clinics of North America. 37 (1): 29–39. doi:10.1016/j.emc.2018.09.005. ISSN 0733-8627.
- ↑ Araujo Filho, Bernardo Cunha; Pinheiro-Neto, Carlos Diógenes; Ramos, Henrique Faria; Voegels, Richard Louis; Sennes, Luiz Ubirajara (2011). "Ligadura endoscópica da artéria etmoidal anterior: estudo de dissecção em cadáveres". Brazilian Journal of Otorhinolaryngology. 77 (1): 33–38. doi:10.1590/S1808-86942011000100006. ISSN 1808-8686.