Epistaxis surgery: Difference between revisions

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Revision as of 22:33, 27 October 2020

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 and non-compliant medical therapy. Most of the time no action is needed to stop epistaxis. In active bleeding nasal compression is the first line to stop bleeding. There are some surgery options to stop bleeding and nasal cautery is the most usual surgery procedure to stop nasal bleeding.

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 and non-compliant medical therapy.^[1] ^[2]

Nasal cautery
- Before cautery anesthesia bleeding site
- Restrict nasal cautery to the site of bleeding
- Nasal cautery is the most usual surgery procedure to stop nasal bleeding.
- Surgical nasal cautery has two options :
  - Electrical cautery
  - Heat 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:
- Embolization and surgical arterial ligation are the most effective procedures.
- When other procedures could not stop bleeding, embolization of bleeding artery and surgical arterial ligation are the best options.

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. When other procedures like nasal compression and some medical therapies could not stop bleeding, there are some surgery options to control bleeding.^[1]

When other procedures could not stop bleeding, embolization of bleeding artery and surgical arterial ligation are the best options.

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.^[1]^[3]

This algorithm 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.

Template:WikiDoc Sources

[TunkelAnne2020-1] 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.

[KrulewitzFix2019-2] 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_FilhoPinheiro-Neto2011-3] 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.

[1]

[2]

[3]

@@ Line 5: / Line 5: @@
 {{CMG}}; {{AE}} [[User:Amir Bagheri|Amir Behzad Bagheri, M.D.]]
 ==Overview==
-Nasal cautery is the most usual surgery procedure to stop nasal bleeding.
+[[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]] and non-compliant [[Epistaxis medical therapy|medical therapy]]. Most of the time no action is needed to stop [[epistaxis]]. In active [[bleeding]] nasal compression is the first line to stop [[bleeding]]. There are some  [[surgery]] options to stop [[bleeding]] and nasal [[cautery]] is the most usual [[surgery]] procedure to stop nasal [[bleeding]].
+== 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]] and 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]]'''
+**Before cautery [[anesthesia]] [[bleeding]] site
+**Restrict nasal [[cautery]] to the site of bleeding
+**Nasal [[cautery]] is the most usual surgery procedure to stop nasal [[bleeding]].
+**Surgical nasal [[cautery]] has two options :
+***[[Electrical]] [[Cauterization|cautery]]
+***[[Heat]] [[Cauterization|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]]:
+**Embolization and [[surgical]] [[arterial]] [[ligation]] are the most effective procedures.
+**When other procedures could not stop [[bleeding]], [[embolization]] of [[bleeding]] [[artery]] and [[surgical]] [[arterial]] [[ligation]] are the best options.
+<br />
 == Indications ==
-* Surgery is the not first-line treatment option for patients with epistaxis, but when other procedures could not stop bleeding, there are other options that include surgery.
+*[[Surgery]] is not the [[first-line treatment]] option for patients with [[epistaxis]]. In active [[bleeding]] nasal compression is the first line to stop [[bleeding]]. When other procedures like nasal compression and some [[Epistaxis medical therapy|medical therapies]] could not stop [[bleeding]], there are some surgery options to control bleeding.<ref name="TunkelAnne2020" />
-== Surgery ==
+* When other procedures could not stop [[bleeding]], [[embolization]] of [[bleeding]] [[artery]] and [[surgical]] [[arterial]] [[ligation]] are the best options.
+== Contraindications ==
-* Nasal cautery is the most usual surgery procedure to stop nasal bleeding and recurrence.<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>
+* 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>
-* A nasal balloon or Foley catheter for posterior bleeds can be indicated.
-* Embolization and surgical arterial ligation are very effective in patients that other procedures could not stop bleeding.
+<br />
+{|
+! colspan="2" align="center" style="background:#DCDCDC;" + |This algorithm 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==
 {{Reflist|2}}