KBB-Forum 2013 , Cilt 12, Sayı 1


Dr. Gaffar ASLAN
Bilim Üniversitesi Tıp Fakültesi Florence Nightingale Hastanesi, KBB ve BBC, İstanbul, Türkiye Objective: To assess the utilization and efficiency of sinus packs with thread in management of posterior nasal bleeding.

Material and Methods: Seventeen patients with posterior epistaxis [6 females (%35) and 11 males (%65) ] aged between 28 and 73 were enrolled in the study. Epistaxis due to tumour, polyp, foreign body, nasal fracture, primary coagulopathy and patients with anterior epistaxis were excluded. Symptoms and findings, localization of bleeding, concomitant diseases, recurrences and treatments were reviewed. The follow-up period was 6-9 months (mean: 7 months).

Findings: All of the 17 patients enrolled in this study had posterior epistaxis. Six patients had posterior epistaxis after endonasal surgery. Foci of bleeding in these patients were determined by endoscopy. Bleeding control was achieved initially with Rhinocell sinus packs. In 11 patients, the focus of bleeding could not be determined, and the bleeding was controlled using with Rhinocell sinus packs. The packs were removed after 72 hours, but 2 patients with uncontrolled hypertension had recurrent epistaxis, and the bleeding was managed with similar nasal packing. One patient with hypertension and chronic renal failure had recurrent epistaxis four days after removal of the nasal packs. The pulsative bleeding focus was posterior to the middle meatus and the epistaxis was managed in the operating room under local anesthesia, using bipolar cautery. No other episodes epistaxis were encountered during their follow-up.

Conclusions: Rhinocell sinus packs are very easily placed to the target area using endoscopes. In one sided epistaxis, as unilateral nasal packing is placed and the opposite side is left open, the patients continue to breathe through the opposite side, and feel less discomfort. Rhinocell sinus pack is efficent in posterior epistaxis management when bleeding focus can not be determined, or multifoci bleeding. It is also a useful and easily applicable method to gain time and prevent blood aspiration in patients with determined epistaxis focus, while taking the patient into the operating room. Keywords : Posterior nasal bleeding, epistaxis, Rhiocell sinus pack, cauterization, endoscopy