Embolization in otolaryngology

Kingsley, D. P. E.; O’Connor, Alec Fitzgerald

doi:10.1017/s0022215100092690

Cited by 20 publications

(9 citation statements)

References 27 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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“…Tseng et al have classified the complications of embolisation into major and minor events 6 . The commonest minor side effect is fever and localised pain due to tissue necrosis 2 . Minor complications are transient, and include facial pain, headaches, mental confusion, paraesthesia, jaw pain, groin pain, numbness and facial oedema.…”

Section: Complicationsmentioning

confidence: 99%

“…Therapeutic embolisation was first used in the management of acute gastrointestinal bleeding in 1972, by Rosch et al , 1 and has since become established in the management of many clinical conditions. Kingsley and O'Connor provided a review on the subject of embolisation in otolaryngology in 1982, noting its application in the management of acute haemorrhage, vascular tumours and angiomatous malformations 2 …”

Section: Introductionmentioning

confidence: 99%

The role of embolisation in ENT: an update

2011

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“…Largely because of significant improvements since that time, surgery has supplanted radiation therapy as the treatment method of choice in most instances (126). Although most cervical paragangliomas are considered radioresistant (127), their skull base counterparts are known to be radiosensitive (128). In patients with unresectable tumors, residual tumor following surgery, or tumor involvement that occludes the ICA, radiation therapy may serve as an excellent palliative modality (59).…”

Section: N Therapy L Radiation Therapymentioning

confidence: 99%

From the Archives of the AFIP

Rao¹,

Koeller²,

Adair³

1999

RadioGraphics

268

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Paragangliomas of the head and neck are ubiquitous in their distribution, originating from the paraganglia or glomus cells within the carotid body, vagal nerve, middle ear, jugular foramen, and numerous other locations. The typical patient is middle-aged and presents late in the course of the disease, with a painless slow-growing mass. Clinical manifestations include hoarseness of voice, lower cranial nerve palsies, pulsatile tinnitus, and other neuro-otologic symptoms. The overall prognosis of patients with a cervical paraganglioma is favorable, whereas its temporal bone counterpart often results in recurrence, residual tumor, and neurovascular compromise when in the advanced stage. Pathologic examination reveals a characteristic biphenotypic cell line, composed of chief cells and sustentacular cells with a peripheral fibrovascular stromal layer that are organized into a whorled pattern ("zellballen"). Imaging hallmarks of paragangliomas of the head and neck include an enhancing soft-tissue mass in the carotid space, jugular foramen, or tympanic cavity at computed tomography; a salt-and-pepper appearance at standard spin-echo magnetic resonance imaging; and an intense blush at angiography. Imaging studies depict the location and extent of tumor involvement, help determine the surgical approach, and help predict operative morbidity and mortality. Surgical treatment is definitive. Radiation treatment is included as a palliative adjunct for the exceptional paraganglioma not amenable to surgery.

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Embolization in otolaryngology

Cited by 20 publications

References 27 publications

Life-Threatening Epistaxis Complicating Extended Maxillotomy for Chordoma

Life-Threatening Epistaxis Complicating Extended Maxillotomy for Chordoma

The role of embolisation in ENT: an update

From the Archives of the AFIP

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