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The distribution of bleeding sites in idiopathic hidden arterial epistaxis

Published online by Cambridge University Press:  01 April 2019

Z-C Lou  and
Z-H Lou
Z-C Lou*
Affiliation:
Department of Otorhinolaryngology, Affiliated Yiwu Hospital of Wenzhou Medical University, Zhejiang, China
Z-H Lou
Affiliation:
Department of Clinical Medicine, Xinxiang Medical University, Henan, China
*
Author for correspondence: Dr Zhen-Cai Lou, Department of Otorhinolaryngology, Affiliated Yiwu Hospital of Wenzhou Medical University, 699 Jiangdong Road, Yiwu, Zhejiang 322000, China E-mail: [email protected] Fax: +86 0579 5209 678
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Abstract

Objective

To determine the frequency distribution of bleeding sites in idiopathic hidden arterial epistaxis.

Methods

In this retrospective cohort study, 107 patients with hidden arterial epistaxis were endoscopically examined for sites of bleeding.

Results

All sites of hidden arterial epistaxis were identified by endoscopic examination. Bleeding sites were identified at initial surgery in 103 patients and during the second surgery in 4. The bleeding sites included: the olfactory cleft region in 47 patients, the inferior meatus region in 29, the middle meatus region in 11, multiple bleeding sites (olfactory cleft and anterior septum) in 3, the anterior roof of the nasal cavity in 4, the nasal floor in 11 and the nasopharynx in 2. The bleeding points showed a white or red volcano-like bump in 75 patients, isolated prominent telangiectasia in 21 and mucosal ulceration in 11.

Conclusion

Common sites of hidden arterial epistaxis include the olfactory cleft, inferior meatus and middle meatus. However, there should be awareness of some uncommon bleeding sites (including the anterior roof of the nasal cavity, the nasal floor and the nasopharynx) and of multiple bleeding sites.

Keywords

EpistaxisNasal CavityAirflowOlfactory
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 133 , Issue 4 , April 2019 , pp. 309 - 312
Copyright
Copyright © JLO (1984) Limited, 2019 

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Footnotes

Dr Z-C Lou takes responsibility for the integrity of the content of the paper

References

1Melia, L, McGarry, GW. Epistaxis: update on management. Curr Opin Otolaryngol Head Neck Surg 2011;19:30–5Google Scholar
2Douglas, R, Wormald, PJ. Update on epistaxis. Curr Opin Otolaryngol Head Neck Surg 2007;15:180–3Google Scholar
3de Bonnecaze, G, Gallois, Y, Chaynes, P, Bonneville, F, Dupret-Bories, A, Chantalat, E et al. Intractable epistaxis: which arteries are responsible? An angiographic study. Surg Radiol Anat 2017;39:1203–7Google Scholar
4Christensen, NP, Smith, DS, Barnwell, SL, Wax, MK. Arterial embolization in the management of posterior epistaxis. Otolaryngol Head Neck Surg 2005;133:748–53Google Scholar
5Dutta, M, Haldar, D. Optimizing the outcome of transnasal endoscopic sphenopalatine artery ligation in managing refractory posterior epistaxis: a case-control analysis. Auris Nasus Larynx 2017;44:554–60Google Scholar
6Pádua, FG, Voegels, RL. Severe posterior epistaxis–endoscopic surgical anatomy. Laryngoscope 2008;118:156–61Google Scholar
7Simmen, DB, Raghavan, U, Briner, HR, Manestar, M, Groscurth, P, Jones, NS. The anatomy of the sphenopalatine artery for the endoscopic sinus surgeon. Am J Rhinol 2006;20:502–5Google Scholar
8Gandomi, B, Arzaghi, MH, Khademi, B, Rafatbakhsh, M. Endoscopic cauterization of the sphenopalatine artery to control severe and recurrent posterior epistaxis. Iran J Otorhinolaryngol 2013;25:147–54Google Scholar
9Shrestha, BL. Endoscopic sphenopalatine artery cauterization in recurrent posterior epistaxis: an experience at Dhulikhel Hospital, Kathmandu University Hospital. Kathmandu Univ Med J (KUMJ) 2014;12:85–6Google Scholar
10Wiorowski, M, Schultz, P, Perrot, JB, Gentine, A, Debry, C. Indications and results of cauterization by endoscopic approach of the sphenopalatine artery in severe posterior epistaxis. Auris Nasus Larynx 2004;31:131–3Google Scholar
11Ando, Y, Iimura, J, Arai, S, Arai, C, Komori, M, Tsuyumu, M et al. Risk factors for recurrent epistaxis: importance of initial treatment. Auris Nasus Larynx 2014;41:41–5Google Scholar
12Iimura, J, Hatano, A, Ando, Y, Arai, C, Arai, S, Shigeta, Y et al. Study of hemostasis procedures for posterior epistaxis. Auris Nasus Larynx 2016;43:298–303Google Scholar
13Liu, J, Sun, X, Guo, L, Wang, D. Posterior epistaxis: common bleeding sites and prophylactic electrocoagulation. Ear Nose Throat J 2016;95:E18–22Google Scholar
14Thornton, MA, Mahesh, BN, Lang, J. Posterior epistaxis: identification of common bleeding sites. Laryngoscope 2005;115:588–90Google Scholar
15Paul, J, Kanotra, SP, Kanotra, S. Endoscopic management of posterior epistaxis. Indian J Otolaryngol Head Neck Surg 2011;63:141–4Google Scholar
16Bhatnagar, RK, Berry, S. Selective surgical packing for the treatment of posterior epistaxis. Ear Nose Throat J 2004;83:633–4Google Scholar
17Chiu, TW, McGarry, GW. Prospective clinical study of bleeding sites in idiopathic adult posterior epistaxis. Otolaryngol Head Neck Surg 2007;137:390–3Google Scholar
18Turri-Zanoni, M, Arosio, AD, Stamm, AC, Battaglia, P, Salzano, G, Romano, A et al. Septal branches of the anterior ethmoidal artery: anatomical considerations and clinical implications in the management of refractory epistaxis. Eur Arch Otorhinolaryngol 2018;275:1449–56Google Scholar
19Segal, RA, Kepler, GM, Kimbell, JS. Effects of differences in nasal anatomy on airflow distribution: a comparison of four individuals at rest. Ann Biomed Eng 2008;36:1870–82Google Scholar
20Zhao, K, Jiang, J. What is normal nasal airflow? A computational study of 22 healthy adults. Int Forum Allergy Rhinol 2014;4:435–46Google Scholar
21Leong, SC, Chen, XB, Lee, HP, Wang, DY. A review of the implications of computational fluid dynamic studies on nasal airflow and physiology. Rhinology 2010;48:139–45Google Scholar
22Hong, SC, Leopold, DA, Oliverio, PJ, Benson, ML, Mellits, D, Quaskey, SA et al. Relation between CT scan findings and human sense of smell. Otolaryngol Head Neck Surg 1998;11:183–6Google Scholar