Angiography in Patients With Intractable Epistaxis

Coel, Marc N.; Janon, Edward A.

doi:10.2214/ajr.116.1.37

Cited by 11 publications

(4 citation statements)

References 2 publications

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“…Arteriographic localization of bleeding points is well described. [9][10][11][12] With recent advances in interven-tional radiology, therapeutic embolization exists as an alternative to arterial ligation. It has the advantage that control of hemorrhage may be obtained as close as possible to the bleeding point.…”

Section: Discussionmentioning

confidence: 99%

Life-Threatening Epistaxis Complicating Extended Maxillotomy for Chordoma

Walsh¹,

Casey²,

Crockard³

2000

Skull Base

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Once considered relatively inaccessible, nestling amid cranial nerves, the clivus has become a reasonable target for the surgeon with the advent of new midline ventral approaches. Since Kanaval' described the transoral removal of a bullet from the clivus in 1909, technique and instrumentation have advanced such that transoral surgery2 and maxillotomy3 provide practical access to the extradural clivus with excellent cosmetic results and few complications. CASE REPORTA previously fit 54-year-old man was admitted to the National Hospital for Neurology and Neurosurgery for removal of a craniocervical chordoma. This lesion occupied the lower 1.5 cm of the clivus, extending around the occipital condyle on the right, and to a much lesser extent on the right. Some tumor extended behind the odontoid peg; the peg itself and the arch of the first cervical vertebra, however, were intact.An "open-door" maxillotomy using a transverse osteotomy at the Le Fort 1 level combined with a midline spit of hard and soft palates was the surgical strategy chosen. Preoperatively a percutaneous gastrostomy was fashioned to permit immediate postoperative feeding. A tracheostomy was inserted at operation. Good exposure of this clivus was obtained by this approach, and radical tumor clearance was effected. The vertebral arteries and their muscular branches were identified and preserved. Closure was meticulous, with fibrin glue and surgical cellulose applied to the tumor defect. The posterior palate was compression wired and the maxilla fixed with mini-plates. The mucoperiostium was closed and hydrocortisone ointment applied to the wound.The patient made an excellent postoperative recovery. Within 5 days, he was taking a light diet orally and was completely self-caring. On the fifth postoperative day, he suffered a massive epistaxis that resulted in this becoming shocked. He initially responded to aggressive fluid resuscitation, and his nasopharynx was packed. Later he described the sensation of a "jet of blood, high up . . . in my nose." The epistaxis recurred and over the next 36 hours this man would require 6 units of blood transfusion. His clotting profiles and liver function were within normal ranges throughout. Pernasal exploration under anesthesia failed to identify the site of his bleeding.153

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Section: Discussionmentioning

confidence: 99%

Life-Threatening Epistaxis Complicating Extended Maxillotomy for Chordoma

Walsh¹,

Casey²,

Crockard³

2000

Skull Base

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“…Reviewing the sites of origin of epistaxis, Malcomson (1963) reported that spontaneous epistaxis in the under-60 age group tends to originate from the external carotid system and those in the over^60 age group from the ethmoidal vessels (internal carotid system). Coel and Janon (1972), however, reported that most spontaneous epistaxes arise from sclerotic sphenopalatine or other internal maxillary artery branches in the posterior portion of the nasal cavity. Both papers are in agreement that traumatic epistaxis usually arises from the ethmoidal vessels.…”

Section: Discussionmentioning

confidence: 99%

“…Arteriographic localization of the source of bleeding in intractable traumatic epistaxis (Duggan and Brylski, 1970) and in spontaneous epistaxis (Coel and Janon, 1972) has been in use for some time. In 1974, Sokoloff etal.…”

Section: Discussionmentioning

confidence: 99%

“…Epistaxis following maxillofacial trauma is uncommon. An incidence of up to 11 per cent is reported in several series (Buchanan and Holtmann, 1983;Luce et al, 1979;Mehrotrae/ al., 1984) and the bleeding following such trauma is usually from the ethmoidal vessels (Coel and Janon, 1972;Duggan and Brylski, 1970;Malcomson, 1963). Post-operative epistaxis following Le Fort I maxillary osteotomy is very rare, with an incidence of 0.75 per cent in one large series (Lanigan and West, 1984).…”

Section: Introductionmentioning

confidence: 99%

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Severe late-onset epistaxis following le Fort I osteotomy: angiographic localization and embolization

Solomons

Blumgart

1988

J. Laryngol. Otol.

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Epistaxis following maxillofacial trauma or maxillofacial surgery is uncommon. It usually occurs within 24 hours of the injury and can usually be controlled by packing. Rarely internal maxillary artery ligation is necessary and embolization has been used in some cases of severe trauma.We present a case of severe late-onset epistaxis following Le Fort I osteotomy. The diagnostic approach and treatment are discussed.

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Percutaneous Embolization to Control Epistaxis in Rendu-Osler-Weber Disease

Strother¹,

Newton²

1976

Archives of Otolaryngology - Head and Neck Surgery

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Angiography in Patients With Intractable Epistaxis

Cited by 11 publications

References 2 publications

Life-Threatening Epistaxis Complicating Extended Maxillotomy for Chordoma

Life-Threatening Epistaxis Complicating Extended Maxillotomy for Chordoma

Severe late-onset epistaxis following le Fort I osteotomy: angiographic localization and embolization

Percutaneous Embolization to Control Epistaxis in Rendu-Osler-Weber Disease

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