Indications for interventional arteriography in post-tonsillectomy hemorrhage.
OBJECTIVE
To determine the incidence of post-tonsillectomy hemorrhage (PTH) and required measures of treatment.


METHODS
Retrospective chart review.


METHODS
Department of Otolaryngology-Plastic Head and Neck Surgery, St. Anna Hospital, Duisburg, Germany.


METHODS
The charts of 5,539 patients at risk for PTH (post-tonsillectomy) and seen in our department between 1988 and 1998 were reviewed including 65 patients primarily operated on elsewhere.


METHODS
Success and failure of surgical methods.


RESULTS
Surgical treatment of PTH was necessary in 145 of our patients (2.65%). Owing to recurrent bleeding in 7 patients, 153 surgical procedures to stop bleeding became necessary. There was one case with lethal outcome (0.018%). Massive bleeding indicated ligature of the external carotid artery (ECA) in 5 patients (0.09%). Despite this procedure, hemorrhage recurred in another 3 patients, all of whom had undergone tonsillectomy elsewhere. In 2 of these cases, arteriography revealed arterial blood supply originating from branches of the internal carotid artery (ICA) or the carotid bulb.


CONCLUSIONS
When ligation of the ECA is considered, a complete dissection of the ICA, ECA, and carotid bulb should be performed to exclude any vascular abnormality. In cases with unclear blood supply of the tonsillar lodge or continuous bleeding despite ligation of the ECA, immediate arteriography of the carotid artery should be indicated. If possible, simultaneous selective embolization of the bleeding vessel should be performed to replace a mutilating approach associated wit exposure and ligation of the ECA.
Windfuhr
Jochen P
JP
Department of Ororhinolaryngology--Plastic Head and Neck Surgery, St Anna Hospital, Duisburg, Germany.
D000328:Adult; D000792:Angiography; D002342:Carotid Artery, External / Q000000981:diagnostic imaging / Q000601:surgery; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000601:surgery; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D019106:Postoperative Hemorrhage / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000628:therapy; D012189:Retrospective Studies; D013997:Time Factors; D014068:Tonsillectomy / Q000009:adverse effects*