scholarly journals Outcome of treatment for severe epistaxis: nasal packing and endoscopic sphenopalatine artery ligation

2021 ◽  
Vol 4 (4) ◽  
pp. 30-35
Author(s):  
J. Galili ◽  
M. Holm Nissen ◽  
T. Ovesen
Keyword(s):  
Risk Factors ◽  
Surgical Treatment ◽  
Descriptive Study ◽  
Nasal Packing ◽  
Good Effect ◽  
Artery Ligation ◽  
Sphenopalatine Artery ◽  
Significant Difference ◽  
Severe Epistaxis ◽  
Time Of Admission

Background: Severe epistaxis is a frequent emergency condition encountered by otolaryngologists and is often treated with nasal packing. In the event of failure surgical treatment is considered. We aimed to evaluate the efficacy of Nasal Packing (NP) and Endoscopic Sphenopalatine Artery Ligation (ESPAL) as treatment of severe epistaxis in terms of failures and recurrences including risk factors. Methodology: Retrospective descriptive study of patients with epistaxis treated with NP, admitted to an ENT department from 2011-2017. If initial treatment with NP failed, patients were considered for ESPAL. Results: An analysis of 511 patients was performed. All patients were treated with NP at the time of admission, and 14% of pa- tients were treated with ESPAL due to failure of NP. The majority of patients was only admitted once. Twelve percent were readmit- ted within 30 days, 7% were readmitted >30 days later. Treatment failure after ESPAL was 7.9%. No significant difference in the risk of readmission was found between patients treated with NP alone and patients treated with ESPAL. Conclusion: The majority of epistaxis patients were effectively treated with NP alone. We found good effect of ESPAL although no significant differences in risk of readmission NP vs. ESPAL were identified.

Cost-effectiveness of endoscopic sphenopalatine artery ligation versus nasal packing as first-line treatment for posterior epistaxis

2013 ◽  
Vol 3 (7) ◽  
pp. 563-566 ◽  
Author(s):  
Raj C. Dedhia ◽  
Shamit S. Desai ◽  
Kenneth J. Smith ◽  
Stella Lee ◽  
Barry M. Schaitkin ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Nasal Packing ◽  
Line Treatment ◽  
First Line ◽  
Artery Ligation ◽  
Sphenopalatine Artery ◽  
First Line Treatment

scholarly journals Patellar tendon rupture - treatment results

2015 ◽  
Vol 68 (1-2) ◽  
pp. 22-28 ◽  
Author(s):  
Nemanja Kovacev ◽  
Jelena Antic ◽  
Nemanja Gvozdenovic ◽  
Mirko Obradovic ◽  
Miodrag Vranjes ◽  
...  
Keyword(s):  
Risk Factors ◽  
Surgical Treatment ◽  
Knee Joint ◽  
Patellar Tendon ◽  
Tendon Rupture ◽  
Lysholm Score ◽  
Patellar Tendon Rupture ◽  
Treatment Results ◽  
Timely Diagnosis ◽  
Significant Difference

Introduction. Patellar tendon rupture is a rare injury which, if missed, leads to delayed surgical treatment and may result in the loss of the knee joint function. The aim of this study was to report our results of operative treatment of the patellar tendon rupture and point out the significance of timely diagnosis and surgical procedure. Material and Methods. This retrospective tenyear study included 20 patients, 15 males and 5 females, their mean age being 42 (20-84) years. Seven participants had an injury on the right side and 13 had an injury on the left side. Thirteen participants had the diagnosis set in the first seven days after the injury. The applied techniques were surgical suture of the tendon, bone-tendon-bone ligamentoplasty using allograft from a bone bank and bone-tendon-bone ligamentoplasty using contralateral autograft, and they were performed in 12, 5 and 3 patients, respectively. The treatment results were assessed by using the Lysholm score, measuring the range of movement in the knee joint and measuring the girth of the thigh 10 cm above the patella. Results. The follow-up period after the surgery was 4 years on average (1-10 years) and the average value of the Lysholm score was 83 (27-100). The result was found to be excellent in 11 cases, satisfactory in 5 cases and unsatisfactory in 4. A statistically significant difference (p=0.0197 p<0.05) was found in the average values of the Lysholm score between the group of patients with risk factors (71.78) and the subjects without risk factors (92.18). A statistically significant difference (p=0.008 p<0.01) was found in the Lysholm score between the patients with timely diagnosis (91.62) and cases of chronic tendon tear (67). Conclusion. Timely diagnosis and early surgical reparation are the basic imperatives in the treatment of this injury. Comorbidity and risk factors are related to a poorer postoperative Lysholm score. The method of choice is early surgical treatment.

Arterial Ligation for Pediatric Epistaxis: Developmental Anatomy

2003 ◽  
Vol 17 (2) ◽  
pp. 75-81 ◽  
Author(s):  
Glenn Isaacson ◽  
Janet M. Monge
Keyword(s):  
Maxillary Artery ◽  
Facial Growth ◽  
Arterial Ligation ◽  
Artery Ligation ◽  
Developmental Anatomy ◽  
Sphenopalatine Artery ◽  
Dental Eruption ◽  
Severe Epistaxis ◽  
Feeding Vessels ◽  
Ethmoidal Arteries

Background Anatomic studies of adult skulls have aided in the design of operations for the surgical ligation of nasal feeding vessels in the treatment of severe epistaxis. Lack of appropriate specimens has prevented similar studies in children. We performed an anthropometric study of archeological specimens to learn the effects of growth on key anatomic relationships. Methods We studied the skulls of children who died between 200 and 8000 years ago, recovered from archeological digs around the world. Measurements of the distances from the posterior lacrimal crest to the foramina of anterior and posterior ethmoidal arteries and optic canal and the pyriform aperture to the foramen of the sphenopalatine artery were made and compared with postnatal age, estimated from facial growth and dental eruption patterns. Results There is rapid growth in the orbit and midface during the first 6 years of life and gradual growth between 7 years and adulthood. The length of the medial wall of the orbit doubles during development with disproportionate enlargement of its anterior half. Conclusion Arterial ligation is sometimes required for intractable pediatric epistaxis, especially after trauma. The changing relationships of critical structures in the orbital must be understood to allow safe ethmoidal artery ligation. The transantral approach to the maxillary artery is greatly limited by lack of midfacial development and maxillary pneumatization. We describe the necessary parameters for endoscopic, transnasal sphenopalatine artery ligation in growing children.

Transnasal Endoscopic Sphenopalatine Artery Ligation Compared With Embolization for Intractable Epistaxis: A Long-term Analysis

2018 ◽  
Vol 32 (3) ◽  
pp. 188-193 ◽  
Author(s):  
G. de Bonnecaze ◽  
Y. Gallois ◽  
F. Bonneville ◽  
S. Vergez ◽  
B. Chaput ◽  
...  
Keyword(s):  
Success Rate ◽  
Significant Risk ◽  
Facial Artery ◽  
Artery Ligation ◽  
Selective Embolization ◽  
Surgical Ligation ◽  
Sphenopalatine Artery ◽  
Significant Difference ◽  
Intractable Epistaxis

Background Transnasal endoscopic sphenopalatine artery ligation (TESPAL) and selective embolization both provide excellent treatment success rate in the management of intractable epistaxis. Few long-term studies comparing these approaches have been previously published. Recommendations often present these techniques as alternatives, but there is no clear consensus. Objective The purpose of this study was to evaluate and compare the clinical efficacy of sphenopalatine artery ligation versus embolization to control intractable epistaxis. Methods We performed a retrospective study including all patients referred to our tertiary medical center for severe epistaxis and treated by surgical ligation and/or embolization. The patients were classified into 2 groups: those who underwent TESPAL only and those who underwent endovascular embolization only. We evaluate and compare long-term clinical outcomes after surgical ligation or embolization for the control of intractable epistaxis in terms of effectiveness (recurrence rate) and safety (complication rate). Results Forty-one procedures of supraselective embolization and 39 procedures of surgical ligation for intractable epistaxis are reported and analyzed. No significant difference was observed between the groups in terms of demographic factors, comorbidities, or average length of hospital stay. The 1-year success rate was similar (75%) in both groups. Complications (minor and/or major) occurred in 34% cases in the embolization group and in 18% in the surgical group ( P = .09, ns). Bilateral embolization including facial artery was the only treatment method associated with a significant risk of complications ( P = .015). Conclusion TESPAL seems to provide a similar control rate with a decrease in the number of complications compared to selective embolization in the context of intractable epistaxis. Further studies are required.

Posterior Epistaxis: Risk Factors and Causes of Recurrence after Sphenopalatine Artery Ligation

2016 ◽  
Vol 59 (5) ◽  
pp. 366 ◽  
Author(s):  
Ho-Joong Lee ◽  
Hyun-Jin Cho ◽  
Yeon-Hee Joo ◽  
Sea-Yuong Jeon ◽  
Sang-Wook Kim
Keyword(s):  
Risk Factors ◽  
Artery Ligation ◽  
Sphenopalatine Artery

scholarly journals Clinical Characteristics and Treatment Outcomes Among Patients With Gastrointestinal Phytobezoars: A Single-Institution Retrospective Cohort Study in Korea

2021 ◽  
Vol 8 ◽  
Author(s):  
Songsoo Yang ◽  
Min Jeng Cho
Keyword(s):  
Risk Factors ◽  
Surgical Treatment ◽  
Treatment Group ◽  
Postoperative Complications ◽  
Treatment Outcomes ◽  
Multivariate Logistic Regression Analysis ◽  
Gastric Surgery ◽  
Treatment Groups ◽  
Significant Difference ◽  
Small Intestinal

Purpose: To describe our experience with phytobezoars, evaluate risk factors on treatment, and analyze whether previous gastric surgery affects treatment outcomes.Methods: Medical records of 51 patients with phytobezoars between 2000 and 2019 were retrospectively evaluated. We compared endoscopic and surgical treatment groups and evaluated risk factors using multivariate logistic regression analysis. And we compared patients with and without previous gastric surgery in the surgical treatment group.Results: The median patient age was 62.9 (range: 27–89) years. The endoscopic and surgical treatment groups included 26 (51%) and 25 (49%) patients, respectively. Patients aged ≥65 years, diabetes, and small intestinal phytobezoars were more frequent in the surgical treatment group. Previous gastric surgery (n = 16, 31.4%) was the most common predisposing risk factor, but without a significant difference between the groups. Enterotomy was performed for 20 patients (80%), segmental resection was performed for five patients (20%). Five patients (20%) had postoperative complications; there was one death. There were no significant differences in age, preoperative diagnosis, operation method, operative time, or postoperative stay between patients with and without previous gastric surgery, but postoperative complications were significantly more common in patients with previous gastric surgery.Conclusions: Phytobezoar should be suspected early in patients with previous gastric surgery or a specific food intake history. Early diagnosis and treatment are important for avoiding surgical intervention and complications, especially in elderly patients. Surgery is required in most patients with small intestinal phytobezoars, safe removal can be achieved mainly via enterotomy.

scholarly journals Changing Trends in the Management of Epistaxis

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Henri Traboulsi ◽  
Elie Alam ◽  
Usamah Hadi
Keyword(s):  
Family Physicians ◽  
Current Treatment ◽  
Nasal Packing ◽  
Treatment Modalities ◽  
Maxillary Artery ◽  
Artery Ligation ◽  
Sphenopalatine Artery ◽  
Changing Trends ◽  
Common Complaint ◽  
Different Types

Epistaxis is a very common complaint seen by many types of physicians including otolaryngologists, family physicians, and others. Management of epistaxis is often challenging and requires many types of intervention. The following review describes the different types of past and current treatment modalities including cautery, nasal packing, maxillary artery ligation, anterior artery ligation, and sphenopalatine artery ligation. The paper also proposes an algorithm for managing such cases.

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