Preoperative Arterial Embolization to Avoid Intraoperative Bleeding during Endoscopic Sinus Surgery for Organized Hematoma of the Maxillary Sinus: A Case Series and Literature Review

Abstract

This study aimed to evaluate the safety and efficacy of preoperative arterial embolization of organized hematoma of the maxillary sinus.Material and Methods: Seven patients who were pathologically diagnosed with an organized hematoma of the maxillary sinus and who underwent endoscopic sinus surgery following preoperative arterial embolization for the same from July 2013 to April 2020 at our hospital were included. A literature review of the Pub-Med database was performed to identify 13 cases on organized hematomas of the maxillary sinuses. The embolization and nonembolization groups comprised patients who underwent preoperative embolization (n = 10, seven from this study and three from literature) and those who did not undergo preoperative embolization (n = 10, from literature), respectively. Outcomes of embolization including embolization-related complications and postoperative bleeding were assessed, and volumes of intraoperative blood loss and duration of surgery were compared between the groups.Results: No preoperative embolization-related complications were observed in our cases. The volume of surgical blood loss in the seven cases varied from 0 to 100 mL with a median of 30 mL, and the duration of surgery ranged from 45 to 166 minutes with a median of 112 minutes. The volume of blood loss was significantly lower for the embolization group than that for the nonembolization group (p = 0.0031). There was no statistically significant difference regarding duration of surgery between the groups (p > 0.10).Conclusions: Preoperative embolization of an organized hematoma of the maxillary sinus is a safe and effective method that helps prevent serious intraoperative hemorrhage.

Sinonasal Organizing Hematoma: Demographics, Diagnosis, and Treatment Outcomes of 112 patients

“…All of our present 112 sinonasal OH patients had surgical removal of the lesion without major bleeding during or after the operation. Although some surgeons prefer an elective embolization for sinonasal OH removal before surgery to reduce bleeding and operation time, 15,16,26 our current patients had a mean operation time of 66.3 ± 28.5 min compared with 104.6 ± 53.6 min in a prior cohort described by Ohta et al ( p = 0.008, t ‐test) 26 . Our current subjects had no severe bleeding episodes during or after surgery, although the volume of blood loss was not properly quantified.…”

“…Only one of our patients (0.9%) developed postoperative bleeding (day 6), which was simply managed with electrocauterization on the middle meatal antrostomy site. Although two prior trials involving preoperative embolization reported no postoperative bleeding episodes, their sample sizes were very small (less than 10 patients in total), 15,16,18 compared with our cohort (112 patients). A routine preoperative embolization is also unnecessary due to the danger of radiation exposure 27 and catastrophic ischemic injury 28 .…”

“…However, we cannot definitively conclude that this is the only reason why this disease is more prevalent in East-Asian regions with an increasing prevalence, and we cautiously suggest that genetic vulnerabilities or environmental factors may also play a role, which is also mentioned by Wu et al 8 that racial disparity may contribute in the epidemiology of sinonasal OH. Most studies on this disease have been published in East Asian countries (Korea, 1,3,6,[10][11][12][13][14]20,24 China, 7 and Japan 2,15,16,18,22 ), whereas only 7 reports from the United States, 8 10 from Brazil, 19 2 from India, 25 and 2 from Tunisia 17 have been documented. Because all our present study patients were of Korean descent, we were unable to further clarify this suggestion of Wu and colleagues.…”

“…Sinonasal OH has been linked previously to hemangioma, 2,8,10 chronic comorbid diseases, 6,11,12 maxillary tooth procedures, 13 nasofacial trauma, 14 and previous sinonasal surgeries. 5,7 Although some scholars have claimed that preoperative embolization may reduce intraoperative blood loss and the elapsed surgical times, 15,16 many other surgeons have demonstrated that endoscopic methods alone may be sufficient to safely remove sinonasal OH in most patients. [6][7][8]13,[17][18][19] In 2016, Pang et al published their clinical, radiological, and treatment findings for 84 sinonasal OH patients that had been treated over a 10-year period in China, which was the largest sample size for this disease to have been documented to date in a single report.…”

“…Sinonasal OH has been linked previously to hemangioma, 2,8,10 chronic comorbid diseases, 6,11,12 maxillary tooth procedures, 13 nasofacial trauma, 14 and previous sinonasal surgeries 5,7 . Although some scholars have claimed that preoperative embolization may reduce intraoperative blood loss and the elapsed surgical times, 15,16 many other surgeons have demonstrated that endoscopic methods alone may be sufficient to safely remove sinonasal OH in most patients 6–8,13,17–19 …”