Preservation or removal of the lateral nasal wall in endoscopic management of maxillary sinus neoplasia: A comparison of approach related morbidity.

BACKGROUND: The endoscopic modified medial maxillectomy (MMM) and prelacrimal approach (PLA) are two routinely performed endoscopic approaches to the maxillary sinus when access via a middle meatal antrostomy is insufficient. However, there is no data in the literature that has compared outcomes and complication profile between the two procedures to determine which approach is superior. OBJECTIVE: To compare the approach related morbidity of PLA and MMM. METHODS: A retrospective cohort study of all consecutive adult patients undergoing either MMM or PLA from 2009 to 2023 were identified. The primary outcome was development of epistaxis, paraesthesia, lacrimal injury, iatrogenic sinus dysfunction within a minimum of 3 months post-operative follow up. RESULTS: 39 patients (44 sides) underwent PLA and 96 (96 sides) underwent MMM. There were no statistically significant differences between the rates of paraesthesia (9.1 % vs 14.6 %, p = 0.367) or prolonged paraesthesia (2.3 % vs 5.2 %, p = 0.426), iatrogenic maxillary sinus dysfunction (2.3 % vs 5.2 %, p = 0.426) or adhesions requiring removal (4.5 % vs 4.2 %, p = 0.918). No cases of epiphora or nasal cavity stenosis occurred in either arm in our study. CONCLUSIONS: According to our data, the endoscopic modified medial maxillectomy and prelacrimal approach are both equally safe approaches with their own benefits to access.

Usefulness of endoscopic endonasal underwater surgery using a combination of coblation and a lens-cleaning system for hemostasis in hereditary hemorrhagic telangiectasia.

Hemostatic procedures for controlling nasal bleeding in refractory diseases such as hereditary hemorrhagic telangiectasia (HHT) can be challenging. In this report, we present a novel technique for underwater endoscopic endonasal hemostatic surgery, which was performed on a 69-year-old man with HHT. The patient had been experiencing frequent episodes of nasal bleeding and had many telangiectasias in the nasal cavity, which were the cause of the bleeding. These telangiectasias were effectively treated using a coblation device in combination with an endoscope lens-cleaning system that supplied saline to create stable underwater conditions. There are several advantages to this technique, including provision of a stable and clear endoscopic field of view, allowing for better visualization of the surgical site. This makes it easier to identify bleeding points and ensure accurate hemostasis. Additionally, the hydrostatic pressure created by the underwater environment helps to reduce bleeding during the procedure. However, it is important to take careful precautions to prevent water from entering the lower airway. With this precautionary measure, this technique is particularly useful in managing bleeding in patients with HHT.

Severe epistaxis after posterior nasal nerve ablation requiring surgical intervention: A multi-center case series.

KEY POINTS: Severe epistaxis occurs in 2% of PNN ablation cases, independent of method or device type. Major epistaxis requiring intervention after PNN ablation can occur on average 20 days post-procedure.

Managing recurrent nosebleeds in children: a retrospective review of 718 children attending a nurse-led epistaxis clinic.

OBJECTIVE: This review assessed the effectiveness of the nurse-led children's epistaxis clinic in streamlining patient care and avoiding unnecessary general anaesthesia. METHODS: A retrospective case note review was conducted of children attending the nurse-led epistaxis clinic between 2019 and 2021. RESULTS: A total of 718 children were seen over three years. Twelve (1.7 per cent) had a known coagulopathy. Of the children, 590 (82 per cent) had visible vessels and 29 (4 per cent) had mucosal crusting. Silver nitrate cautery was attempted under topical anaesthesia in 481 children, with 463 (96 per cent) successful cauterisations. Fifteen (3 per cent) were cauterised under general anaesthesia. Of the children, 706 (99 per cent) were prescribed nasal antiseptic preparations; this was the sole treatment for 58 (8 per cent). Blood investigations were requested for eight children (1 per cent) and haematology referral for three (0.4 per cent). CONCLUSION: This is the largest published series of children's nosebleeds. Given the short-lived benefit from cautery, it is suggested that general anaesthesia should not be offered routinely. However, improved haematology referral criteria are required to increase underlying diagnosis.

Strategy of the diagnosis and treatment for epistaxis and guideline for clinical application of MasterPillar / 临床耳鼻咽喉头颈外科杂志

Epistaxis is a common otorhinolaryngological emergency with complex etiological factors and varied clinical manifestations. The key to epistaxis treatment is accurate diagnosis and adequate hemostasis. Electrocoagulation is a reliable, safe and effective treatment for epistaxis. However, there are still several deficiencies in application of the commonly used electrocoagulation surgical products. This paper introduces a new type of radiofrequency head incorporating the dynamic circulatory functions of drip, irrigation, hemostasis and aspiration. We aim to achieve noninvasive, effective and accurate hemostasis in the treatment of epistaxis or nasal sinus surgery.

Cirugía de Young para el tratamiento quirúrgico de la epistaxis en telangiectasia hemorrágica hereditaria: reporte de un caso y revisión de la literatura / Young's procedure for surgical treatment of epistaxis in hereditary hemorrhagic telangiectasia: A case report and literature review

La telangiectasia hemorrágica hereditaria (THH) es una displasia vascular multisistémica, de herencia autosómica dominante, caracterizada por el desarrollo de telangiectasias mucocutáneas y malformaciones arteriovenosas viscerales. El diagnóstico se realiza mediante los criterios de Curasao publicados en el año 2000 y su manejo requiere de un equipo multidisciplinario donde el rol del otorrinolaringólogo(a) es fundamental, puesto que la epistaxis se presenta en un 90%-95% de los pacientes siendo una de las primeras manifestaciones clínicas de la enfermedad y pudiendo amenazar la vida del paciente. En la literatura se describen múltiples alternativas de tratamiento médico y quirúrgico para la epistaxis, sin existir un tratamiento definitivo para la enfermedad. A continuación, presentaremos el caso de una paciente de 56 años con THH y epistaxis recurrentes severas que, tras no responder al tratamiento médico conservador y múltiples procedimientos quirúrgicos, se realizó el cierre nasal mediante el procedimiento de Young, constituyendo el primer caso reportado en nuestro país.

Hereditary hemorrhagic telangiectasia (HHT) is a multisystemic vascular dysplasia, of autosomal dominant inheritance, characterized by the development of mucocutaneous telangiectasias and visceral arteriovenous malformations. The diagnosis is made using the Curafao criteria published in 2000 and its management requires a multidisciplinary team where the role of the ENTs is fundamental, since epistaxis occurs in 90%-95% of patients, being one of the first clinical manifestations of the disease and may threaten the life of the patient. Multiple medical and surgical treatment alternatives for epistaxis are described in the literature without a definitive treatment for the disease. Here, we present the case of a 56-year-old patient with severe recurrent HHT and epistaxis who, after not responding to the initial conservative and surgical treatments, a nasal closure was performed, using the Young's procedure, constituting the first case reported in our country.

Manejo de las epistaxis graves y/o refractarias / Management of severe and/or refractory epistaxis

Introducción y objetivos: El objetivo fue determinar los resultados del tratamiento de las epistaxis graves y/o refractarias que requirieron ingreso hospitalario. Además se compararon los resultados del tratamiento mediante ligadura arterial o embolización. Material y método: Se incluyeron de forma prospectiva 63 pacientes con epistaxis grave y/o refractaria que requirieron ingreso hospitalario entre agosto de 2014 y diciembre de 2016. Resultados: En 11 pacientes (17%) se realizó embolización, 5 (8%) fueron intervenidos mediante endoscopia y en los 47 restantes (75%) se realizó tratamiento conservador. La edad media de los pacientes en los que las medidas conservadoras fueron suficientes fue de 72 años, mientras que la edad de aquellos tratados con embolización fue de 71 años y de los que fueron intervenidos quirúrgicamente fue de 53 años. En los pacientes sometidos a tratamiento conservador o a cirugía la estancia media fue de 6 días, frente a 9 días en aquellos en los que se realizó embolización. Un paciente sufrió un ictus hemisférico tras la embolización. No se observaron complicaciones posquirúrgicas. Conclusiones: La mayoría de los pacientes con epistaxis graves y/o refractarias se resuelven mediante taponamiento convencional. El tratamiento mediante ligadura arterial está asociado a una disminución de la estancia hospitalaria, sin observarse complicaciones graves. Es aconsejable disponer de todas las opciones terapéuticas posibles para lo cual la presencia de radiólogos intervencionistas y cirujanos experimentados es fundamental para evitar complicaciones y decidir el tratamiento a realizar de forma individual en cada paciente

Objective: The objective was to determine the results of the treatment of severe and/or refractory epistaxis requiring hospital admission. In addition, the results of arterial ligation versus embolization were compared. Material and method: Sixty-three patients with severe and/or refractory epistaxis requiring hospital admission between August 2014 and December 2016 were included prospectively. Results: Eleven patients (17%) underwent embolization, 5 (8%) endoscopy ligation and the remaining 47 (75%) underwent conservative treatment with tamponade. The mean age of the patients in which conservative measures were sufficient was 72 years, while the age of those treated with embolization was 71 years and of those who underwent surgery was 53 years. For the patients who underwent conservative treatment or surgery, the average stay was 6 days, compared to 9 days for those who underwent embolization. One patient suffered a hemispheric stroke after embolization. No post-surgical complications were observed. Conclusions: Most cases of severe and/or refractory epistaxis are resolved by conventional tamponade. Endoscopy ligation is associated with a decrease in hospital stay, without serious complications. It is advisable to have all the possible therapeutic options available, for which the presence of interventional radiologists and experienced surgeons is essential to avoid complications and decide the treatment to be performed individually for each patient

Telangiectasia hemorrágica hereditaria: a propósito de un caso clínico / Hereditary hemorrhagic telangiectasia: on the subject of a clinical case

La epistaxis, es un síntoma frecuente en la consulta de otorrinolaringología. Dentro de las causas posibles encontramos la telangiectasia hemorrágica hereditaria (síndrome de Rendu Osler Weber), que corresponde a un desorden autosómico dominante caracterizado por sangrados nasales y gastrointestinales asociados a malformaciones arteriovenosas sistémicas. Su manifestación más frecuente es la epistaxis, presentándose más frecuentemente en personas mayores de 40 años, sin predilección por género. Se presenta el caso de un paciente de sexo masculino de 46 años quien consulta por epistaxis a repetición y severa. Durante la hospitalización se efectúa el tratamiento convencional de la epistaxis, diagnóstico retroactivo del síndrome de Rendu Osler Weber y manejo multidisciplinario de la patología. Se realiza revisión de la literatura y discusión del manejo del paciente que cursa con esta enfermedad.

Epistaxis is a common symptom in the otorhinolaryngology consultation. Among the possible causes are hereditary hemorrhagic telangiectasia (Rendu Osler Weber syndrome), which corresponds to an autosomal dominant disorder characterized by nasal and gastrointestinal bleeding associated with systemic arteriovenous malformations. Its most frequent manifestation is epistaxis, presenting more frequently in people over 40 years of age, without gender preference. We present the case of a male patient of 46 years old who consults for recurrence and severe epistaxis. During hospitalization, conventional treatment of epistaxis, retroactive diagnosis of Rendu Osler Weber syndrome and multidisciplinary management of pathology are performed. We review the literature and discuss the management of patients with this disease.

Manejo de epistaxis posterior en el Hospital Clínico de la Universidad de Chile entre los años 2013 y 2016 / Treatment of posterior epistaxis in the Clinical Hospital of the University of Chile between the years 2013 and 2016

Introducción: La epistaxis corresponde a una de las causas más frecuentes de consulta otorrinolaringológica en los servicios de urgencia. La epistaxis posterior es menos frecuente pero su presentación más severa. Existen varias alternativas terapéuticas, en las últimas décadas el manejo quirúrgico endoscópico de la arteria esfenopalatina (AEP) ha ido en aumento dado las ventajas en comodidad para el paciente y reducción de costos asociados. Objetivo: Revisar el manejo realizado en los cuadros de epistaxis posterior en el Hospital Clínico de la Universidad de Chile (HCUCh). Material y método: Estudio descriptivo en el Servicio de Otorrinolaringología del HCUCh de pacientes que presentaron epistaxis posterior entre el año 2013 y 2016. Resultados: Se revisó un total de 33 casos. La edad promedio de los pacientes fue 61,6 años siendo las comorbilidades más frecuentes la hipertensión arterial (36,3%) y fibrilación auricular (18,1%). Se realizó tratamiento quirúrgico en 57,6% de los pacientes siendo el clipaje de AEP la intervención quirúrgica más frecuente. Discusión y conclusiones: Tanto el manejo tradicional como las técnicas quirúrgicas presentaron eficacia similar en la serie revisada.

Introduction: Epistaxis corresponds to one of the most frequent causes of otorhinolaryngological consultation in the emergency services. Posterior epistaxis is less frequent but more severe. There are several therapeutic alternatives, in recent decades the surgical endoscopic management of the sphenopalatine artery (AEP) has been increasing given the advantages in comfort for the patient and reduction of associated costs. Aim: To review the management of posterior epistaxis in the Clinical Hospital of the University of Chile (HCUCh). Material and method: Descriptive study in the Otorhinolaryngology Service of the HCUCh of patients who presented posterior epistaxis between the years 2013 and 2016. Results: A total of 33 cases were reviewed. The mean age of the patients was 61.6 years, with the most frequent comorbidities being hypertension (36.3%) and atrial fibrillation (18.1%). Surgical treatment was performed in 57.6% of the patients, with AEP clipping being the most frequent surgical intervention. Conclusion: Both traditional management and surgical techniques presented similar efficacy in the revised series.

Nasal closure for the treatment of epistaxis secondary to hereditary hemorrhagic telangiectasia / Cierre nasal para el tratamiento de la epistaxis secundaria a Telangiectasia Hemorrágica Hereditaria

Hereditary hemorrhagic telangiectasia (HHT), also known by the eponym Osler-Weber-Rendu syndrome, is an autosomal dominant disorder characterised by the presence of multiple arteriovenous malformations (AVMs) affecting multiple organs. Many procedures have been used for epistaxis control in patients with this disorder. The objective of this study was to report the treatment of severe HHT-related epistaxis with the modified Young’s procedure. Materials and methods: We describe the treatment of 4 patients with severe blood-transfusion dependent epistaxis who underwent a modified Young’s procedure in a tertiary hospital. The nasal closure was bilateral and complete in all cases. All patients were followed for 12 months or longer. Results: The procedure was well tolerated and complete cessation of bleeding was achieved in all the patients. Conclusion: Young’s technique is a safe surgical procedure, well tolerated by patients with severe epistaxis and HHT (AU)

La telangiectasia hemorrágica hereditaria (HHT), también conocida por el epónimo síndrome de Osler-Weber-Rendu es un trastorno autosómico dominante caracterizado por la presencia de malformaciones arteriovenosas (MAV) que afectan a múltiplos órganos y sistemas. Un gran número de procedimientos fue utilizado para el control de epistaxis en estos pacientes. El objetivo de este estudio fue reportar el tratamiento de las epistaxis severas relacionadas con HHT con procedimiento de Young modificado. Materiales y métodos: Describimos cuatro pacientes con epistaxis severa, dependientes de transfusiones de sangre, que se sometieron a un procedimiento de Young modificado en un hospital de tercer nivel. El cierre nasal fue bilateral y completo en todos los casos. Se observaron todos los pacientes durante 12 meses o más. Resultados: El procedimiento fue bien tolerado y se logró el cese completo de las hemorragias en todos los pacientes. Conclusión: La cirugía de Young es un procedimiento seguro y bien tolerado por los pacientes con epistaxis severa y HHT (AU)

Rinosporidiosis / Rhinosporidiosis

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Epistaxis en un paciente con seudoaneurisma de la arteria maxilar interna como complicación de una osteotomía de LeFort tipo 1: reporte de un caso / Epistaxis in patient with pseudoaneurysm of the internal maxillary artery as a complication of LeFort I osteotomy: a case report

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Epistaxis severas. Nuestra experiencia y revisión de literatura / Severe epistaxis. Our experience and review of literature / Epistaxe grave. A nossa experiência e revisão da literatura

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...

Epistaxe: da etiologia ao manejo / Epistaxis: from etiology to management

A hemorragia nasal ou epistaxe é a mais frequente entre as hemorragias e apresenta alta prevalência na população em geral. Na maioria das vezes, tem resolução espontânea. Entretanto, quando o atendimento médico for requisitado, é essencial o domínio das principais causas desta patologia para realização de correta abordagem diagnóstica e adequado manejo terapêutico.

Nasal bleeding or epistaxis is the most common cause of bleeding and has a high prevalence in the general population. Most often it solves spontaneously. However, when it becomes necessary medical care, it is essential the knowledge of the main causes of this condition to perform correct diagnosis and appropriate therapeutic management approach.

Tratamento cirúrgico da epistaxe grave: experiência de 11 anos / Surgical treatment of severe epistaxis: an eleven-year experience

A epistaxe é uma das urgências otorrinolaringológicas de maior prevalência, cujas alternativas de tratamento cirúrgico cada vez mais fazem parte do dia-a-dia dos serviços de pronto-atendimento, principalmente naqueles casos refratários às condutas clínicas. OBJETIVO: Analisar o perfil dos pacientes e os resultados deste serviço no tratamento cirúrgico da epistaxe durante 11 anos. MÉTODO: Foram analisados dados retrospectivos de 98 pacientes, submetidos a tratamento cirúrgico para epistaxe entre 2000 e 2011. RESULTADOS: A maior parte da amostra foi de homens, com média de idade em torno de 46 anos. A hipertensão arterial sistêmica foi identificada em 58% dos pacientes e a época do ano em que os eventos mais ocorreram foi durante o outono e o inverno. A taxa de ressangramento foi de 13,27%. CONCLUSÃO: O presente estudo pôde concluir que o tratamento cirúrgico das epistaxes, quando indicado, tem bom índice de sucesso, com baixa incidência de complicações, e continua sendo, para este serviço, o tratamento padrão-ouro para as hemorragias nasais refratárias às medidas iniciais de manejo.

Epistaxis is one of the most prevalent emergencies in ENT practice, and its surgical treatment is part of the routine at services for emergency care, especially in cases refractory to clinical procedures. OBJECTIVE: To analyze the profile of patients and the results this service has had in the surgical treatment of epistaxis for the last 11 years. METHOD: Data from 98 patients submitted to surgery for epistaxis between 2000 and 2011 were analyzed retrospectively. RESULTS: Most in the sample were males, and mean age was around 46 years. Hypertension was identified in 58% of patients, and most events occurred during fall and winter. The re-bleeding rate was 13.27%. CONCLUSION: This study concluded that the surgical treatment for epistaxis, when indicated, had good success rates and low incidence of complications. In our service, it remains as the gold-standard procedure for nosebleeds refractory to initial management measures.

Artéria esfenopalatina: desafio cirúrgico na epistaxe / The sphenopalatine artery: a surgical challenge in epistaxis

O conhecimento anatomocirúrgico da artéria esfenopalatina (AEP) e de seus ramos é de fundamental importância para o sucesso no tratamento endoscópico da epistaxe posterior. Contudo, essa complexa variação anatômica da irrigação da cavidade nasal ainda é um desafio cirúrgico. OBJETIVO: Descrever a anatomia endoscópica da AEP em cadáveres humanos. CASUÍSTICA E MÉTODOS: Estudo de coorte histórica com corte transversal de abril de 2010 a agosto de 2011. Foi descrita a presença da crista etmoidal da lâmina perpendicular do osso palatino, a localização do forame esfenopalatino principal (FEP) e acessório (FEA) e quantificados os ramos que emergem dos forames. RESULTADOS: Foram analisadas 56 fossas nasais. A crista etmoidal estava presente em 96% dos casos e na maioria das vezes anterior ao FEP. O FEP se localizava na transição do meato médio para o meato superior em todos os casos. O FEA estava presente em 12 casos. Foi mais prevalente a presença de um único tronco arterial bilateral na emergência do FEP (43%). Em outros casos, observaram-se três (n = 8) e dois (n = 5) troncos arteriais, emergindo do FEP bilateralmente. Observou-se que na maioria dos casos um único tronco se emergia do FEA. CONCLUSÕES: A anatomia da artéria esfenopalatina é bastante variável. O conhecimento das possíveis variações anatômicas implica no sucesso do tratamento da epistaxe grave.

Knowledge on the anatomy of the sphenopalatine artery (SPA) and its branches is fundamental for the success of the endoscopic treatment of posterior epistaxis. However, the complex anatomical variations seen in the irrigation of the nasal cavity poses a significant surgical challenge. OBJECTIVE: This paper aims to describe the endoscopic anatomy of the SPA in human cadavers. MATERIALS AND METHODS: This is a contemporary cross-sectional cohort study carried out between April 2010 and August 2011. The presence of the ethmoidal crest on the lamina perpendicular to the palatine bone and the location of the principal sphenopalatine foramen (PSF) and the accessory sphenopalatine foramen (ASF) were analyzed in 28 cadavers, and the branches emerging from the foramens were counted. RESULTS: Fifty-six nasal fossae were analyzed. The ethmoidal crest was present in 96% of the cases and was located anteriorly to the PSF in most cases. The PSF was located in the transition area between the middle and the superior meatus in all cases. The ASF was seen in 12 cases. Most nasal fossae (n = 12) presented a single bilateral arterial trunk emerging from the PSF. In other cases, three (n = 8) or two (n = 5) arterial trunks emerged bilaterally from the PSF. In most cases, the SPA emerged as a single trunk from the ASP. CONCLUSIONS: The anatomy of the SPA is highly variable. The success of the treatment for severe epistaxis relies heavily on adequate knowledge of the possible anatomical variations of the sphenopalatine artery.

Tratamiento endoscópico de las epistaxis posteriores: Experiencia del Hospital Clínico de la Universidad de Chile entre los años 2007 y 2011 / Endoscopic treatment of posterior epistaxis: Experience at the Hospital Clínico de la Universidad de Chile between the years 2007 and 2011

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.

Ligadura de la arteria esfenopalatina en la epistaxis recidivante posterior. Estudio retrospectivo de 50 pacientes / Ligation of the sphenopalatine artery in posterior epistaxis. Retrospective study of 50 patients

Objetivos: Queremos estudiar la efectividad y las ventajas de la ligadura de la arteria esfenopalatina en el tratamiento de la epistaxis recurrente posterior. Métodos: Hemos realizado un estudio retrospectivo sobre un total de 50 pacientes ingresados en nuestro servicio por epistaxis recidivante posterior en los que el taponamiento nasal posterior resultó ineficaz. A todos ellos se les realizó la ligadura endoscópica de la arteria esfenopalatina para controlar dicha hemorragia. Resultados: De todos los pacientes intervenidos, sólo 7 presentaron recidiva de la epistaxis. Uno de ellos fue resuelto ligando la arteria etmoidal anterior; otro ligando, asimismo, la arteria esfenopalatina contralateral; otro se encuentra en estudio por una alteración de la coagulación no filiada, ya que se le han ligado las arterias esfenopalatina, etmoidal anterior y etmoidal posterior homolaterales, y las epistaxis persisten; y los 4 restantes se controlaron con un taponamiento nasal anteroposterior. El resto de pacientes fue dado de alta a los 2 días de la intervención, sin recidiva ni otras complicaciones relacionadas con la intervención. Conclusiones: Creemos que la ligadura endoscópica de la arteria esfenopalatina es una técnica segura, con escasos efectos secundarios, que minimiza las molestias y complicaciones de otros métodos como el taponamiento nasal o la embolización arterial (AU)

Objectives: The aim of this study was to evaluate the efficacy of endoscopic ligation of the sphenopalatine artery in the treatment of severe posterior epistaxis. Methods: We have carried out a retrospective study on 50 patients hospitalised with posterior recurrent epistaxis, in whom posterior nasal packing was not effective. All of them underwent surgical treatment, with endoscopic ligation of the sphenopalatine artery to control the epistaxis. Results: Only seven patients had a new epistaxis after surgery. One of them is being studied for some kind of coagulopathy, another patient was controlled by ligation of the anterior ethmoidal artery and it was necessary to ligate the contralateral sphenopalatine artery in a third patient. The other four patients were controlled with posterior nasal packing and discharged two days after surgery, without any complications. Conclusions: We believe that endoscopic ligation of the sphenopalatine artery is a safe technique, with fewer complications than other methods such as posterior packing or embolisation (AU)

Surgical treatment of nasal packing refractory epistaxis / Tratamento cirúrgico de epistaxes refratárias ao tamponamento nasal

Epistaxis is the main otorhinolaryngology emergency and, in severe cases, it can lead to hemodynamic instability and be life threatening. AIM: To evaluate factors involved in epistaxis resistant to nasal packing that needed surgical treatment, as well as post-surgical results. MATERIAL AND METHODS: Retrospective study from January 2002 to August 2007. 40 consecutive patients that underwent surgical treatment for refractory epistaxis were analyzed. Predisposing factors, procedures performed, need of blood transfusion, and recurrence were evaluated. RESULTS: Otorhinolaryngology post operative complications (37.5 percent), high blood pressure (30 percent), and coagulopathy (15 percent) were the main factors related to epistaxis. 50 percent of the patients (n=20) presented with hemodynamic instability and 90 percent of them (n=18) needed blood transfusion. Eletrocauterization of the bleeding site was enough in 35 percent of these patients (n=14), while in 65 percent (n=26) was necessary cauterization and/or arterial ligation. Five patients (12.5 percent) had bleeding recurrence, which needed re-operation. CONCLUSION: Earlier indications of surgical treatment to control severe and refractory epistaxis to conventional treatment, especially in a population with high risk such as post operative bleeding and coagulopathies, may decrease the need of blood transfusion.

A epistaxe é a principal emergência otorrinolaringológica e, em casos graves, pode comprometer a estabilidade hemodinâmica colocando em risco a vida do paciente. OBJETIVO: Avaliar fatores envolvidos na epistaxe e a evolução de pacientes que necessitaram de tratamento cirúrgico em casos refratários a tratamento com tamponamento nasal. MATERIAL E MÉTODOS: Estudo retrospectivo transversal, sendo avaliados 40 pacientes consecutivos com epistaxe refratária a tratamento clínico convencional que necessitaram de tratamento cirúrgico, entre o período de janeiro de 2002 a agosto de 2007. Foram avaliados fatores relacionados à epistaxe, bem como os resultados pós-operatórios. RESULTADOS: Os principais fatores relacionados foram complicações pós-operatórias de cirurgia otorrinolaringológica (37,5 por cento), hipertensão arterial sistêmica (30 por cento) e coagulopatia (15 por cento). Como complicação da epistaxe, 50 por cento (n=20) apresentaram instabilidade hemodinâmica e 90 por cento desses (n=18) necessitaram de transfusão sanguínea. Em 35 por cento dos pacientes (n=14) foi necessária apenas a cauterização elétrica do sítio sangrante, enquanto que 65 por cento (n=26) necessitaram de cauterização e/ou ligadura vascular. Em cinco casos (12,5 por cento) houve recorrência da epistaxe necessitando de reintervenção cirúrgica. CONCLUSÕES: Em pacientes sob risco de epistaxe grave, como sangramento pós-operatório e coagulopatia, indicações cirúrgicas mais precoces poderiam diminuir a necessidade de transfusões sanguíneas.

Implicações cirúrgicas de anatomia endoscópica da região do forame esfenopalatino / Surgical implication of the endoscopic shenopalatine forame region's anatomy

A falha terapêutica da cirurgia da ligadura da artéria esfenopalatina é descrita na literatura de 2-10 por cento, podendo estar relacionada a variações anatômicas nesta região...

The failure rate of the sphenopalatine artery ligation has been described varying from 2 to 10 per cent, and a may occur because of anatomical variations found in these region...