Surgical Management of Epistaxis

Overview

Epistaxis, or nosebleed, can be a challenging condition to manage, especially when it is severe or recurrent. Surgical management may be necessary when conservative measures fail to control the bleeding.

Indications for Surgical Management

1. Severe or recurrent bleeding

Bleeding that is difficult to control or recurs frequently.
2. Failed conservative managemen

When nasal packing, cauterization, or other conservative measures fail to control the bleeding.
3. Significant blood loss

When the bleeding is significant enough to cause hemodynamic instability.

Surgery

Surgical Options

1. Endoscopic sphenopalatine artery ligation (ESPAL)

A minimally invasive procedure that involves ligating the sphenopalatine artery to control bleeding.
2. Anterior ethmoidal artery ligation

Ligation of the anterior ethmoidal artery to control bleeding from the anterior nasal septum.
3. External carotid artery ligation

Ligation of the external carotid artery to control bleeding from the nasal cavity.

Step-by-Step Procedure

The specific steps of the procedure will depend on the surgical approach chosen. However, the general steps include:

1. Preparation

The patient is prepared for the procedure, and the nasal cavity is anesthetized.
2. Endoscopy

A nasal endoscope is used to visualize the nasal cavity and identify the source of bleeding.
3. Ligation of blood vessels

The blood vessels are ligated using clips, sutures, or other methods.
4. Cauterization

The bleeding site may be cauterized to ensure hemostasis.

Management

Postoperative Management

1. Nasal packing

Nasal packing may be used to support the nasal mucosa and prevent re-bleeding.
2. Pain management

Pain relief medication is prescribed to manage postoperative pain.
3. Follow-up

Regular follow-up appointments are necessary to monitor healing and remove any packing.

Complications

1. Re-bleeding

Bleeding can recur if the ligation is not successful or if there are other sources of bleeding.
2. Nasal septal perforation

Perforation of the nasal septum can occur if the mucosa is damaged during the procedure.
3. Infection

As with any surgical procedure, there is a risk of infection.

Surgical management of epistaxis is a effective option for controlling severe or recurrent bleeding that is not responsive to conservative measures. The choice of surgical procedure depends on the source of bleeding and the patient’s overall condition.

Want to Know More of

Epistaxis

Nosebleeds (epistaxis) can be alarming, but most cases can be managed with simple first aid. Here’s what you need to know. . . . . . . . . . . . . . . . . . . . .

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