title: Nasal packing in sphenopalatine artery bleeding: therapeutic or harmful?
abstract: The aim of this study is to present our management protocol of sphenopalatine artery bleeding, demonstrating that nasoendoscopic cautery (NC) was a more effective method than the nasal packing, in terms of shorter inpatient stay and reduced complications rate. We present ten posterior epistaxis not resolved by nasal packing. Tabotamp®was placed in the area of sphenopalatine foramen and/or in those parts of the posterior nasal cavity, where it was suspected that bleeding origins. In two cases, the bleeding was resolved in this way, instead eight cases needed of subperiosteal cauterization of sphenopalatine artery by Dessi bipolar forceps (MicroFrance®). 4 of these 8 patients evidenced a remarkable bleeding removing nasal packing (Hb before-nasal packing = 15 ± 0.69 versus Hb after-nasal packing = 13.3 ± 0.81; t student = 2.94; p value = 0.025). These four patients showed a deviation of the nasal septum ipsilateral to epistaxis, and according our experience, a traumatism of sphenopalatine area can be caused by Merocel®nasal packing in this condition. During follow-up, no recurrences of nasal bleeding have been observed in such patients. Nasal packing must be considered if posterior epistaxis is severe, but always taking into account the specific anatomy of patient and in particular septal spurs that can further compromise sphenopalatine artery. In our experience, the endoscopic endonasal cauterization of the sphenopalatine branches represented a safe and effective procedure.
authors.affiliation: Otorhinolaryngology Section, Department of Experimental Biomedicine and Clinical Neurosciences (BioNeC), University of Palermo, via del Vespro 129, 90127, Palermo, Italy. federicosireci@hotmail.it.
authors.forename: F
authors.initials: F
authors.lastname: Sireci
authors.affiliation: Otorhinolaryngology Section, Department of Experimental Biomedicine and Clinical Neurosciences (BioNeC), University of Palermo, via del Vespro 129, 90127, Palermo, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Speciale
authors.affiliation: Otorinolaryngology Section, SS Antonio Biagio e Cesare Arrigo Hospital, Alessandria, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Sorrentino
authors.affiliation: Department of Otorhinolaryngology, University of Insubria, Varese, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Turri-Zanoni
authors.affiliation: Otorinolaryngology Section, SS Antonio Biagio e Cesare Arrigo Hospital, Alessandria, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Nicolotti
authors.affiliation: Otorinolaryngology Section, SS Antonio Biagio e Cesare Arrigo Hospital, Alessandria, Italy.
authors.forename: F R
authors.initials: FR
authors.lastname: Canevari
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001158:Arteries / Q000601:surgery*; D001458:Bandages / Q000009:adverse effects*; D004564:Electrocoagulation; D004724:Endoscopy; D004844:Epistaxis / Q000209:etiology / Q000628:therapy*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009296:Nasal Cavity / Q000098:blood supply; D009300:Nasal Septum / Q000293:injuries; D012189:Retrospective Studies; D013630:Tampons, Surgical
keywords: Bleeding; Nasal packing; Septal spur; Sphenopalatine artery