title: [Management of intractable epistaxis and bleeding points localization].
abstract: OBJECTIVE
  To investigate the common nasal bleeding points and the management of intractable epistaxis.
  
  
  METHODS
  The bleeding points and its correlation with age distribution, surgical techniques as well as its effects were studied retrospectively in 92 patients, in whom the bleeding points were not found by routine nasal endoscopy and the hemorrhage was not controlled with standard nasal packing.
  
  
  RESULTS
  The bleeding points were found in the following different sites: superior wall of inferior nasal meatus (56.5%, 52/92), olfactory cleft of nasal septum (27.2%, 25/92), posterosuperior wall of middle nasal meatus (8.7%, 8/92) and uncertain (7.6%, 7/92). The results showed that the bleeding points had correlation with age. Epistaxis was well controlled by electrocoagulation in 83 cases, gelfoam packing in 8 cases, and transcatheter maxillary artery embolization in 1 case. There were no complications during a followed-up for 1 - 3 months after management. Among the 92 cases, the numbers of treatment needed to stop bleeding were 82 cases (89.1%) after 1 time of treatment, 9 cases (9.8%) after 2 times and in one case (1.1%) after 4 times.
  
  
  CONCLUSIONS
  Endoscopy combined with displacement of the middle and inferior turbinate gives good visualization and direct management of the deeply-sited bleeding points, which were difficult in localization. The combined method provides an effective and safe way to control intractable epistaxis.
authors.affiliation: Department of Otorhinolaryngology, China-Japan Friendship Hospital, Beijing 100029, China. yangdazhang2000@yahoo.com.cn
authors.forename: Da-Zhang
authors.initials: DZ
authors.lastname: Yang
authors.forename: Jing-Ning
authors.initials: JN
authors.lastname: Cheng
authors.forename: Jun
authors.initials: J
authors.lastname: Han
authors.forename: Ping
authors.initials: P
authors.lastname: Shu
authors.forename: Hua
authors.initials: H
authors.lastname: Zhang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004564:Electrocoagulation; D004724:Endoscopy; D004844:Epistaxis / Q000175:diagnosis / Q000473:pathology* / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D055815:Young Adult