ELECTROCAUTERIZATION OR CHEMICAL CAUTERIZATION FOR ANTERIOR SEPTAL EPISTAXIS?
1Florence Nightingale Hastanesi, KBB ve BBC, İstanbul, Türkiye2İstanbul Bilim Üniversitesi Tıp Fakültesi, KBB ve BBC, İstanbul, Türkiye Aim: Investigation of electrocauterization and chemical cauterization choosing criteria in treatment of anterior septal epistaxis carried out with cauterization method.
Material and Method: The data of 130 patients who were treated with chemical cauterization and electrocauterization for anterior septal epistaxis were prospectively reviewed and were included in the study. Topical and local anesthesia were applied before cauterization. Antibiotic ointment and isotonic solution were applied to nasal cavity after cauterization. Patients were examined for four times with intervals of one week after cauterization.
Results: 64 out of 130 patients underwent chemical cauerization with silver nitrate and remaining 66 patients underwent electrocauterization. Hemostasis was achieved at the first application in 61 out of 64 patients who underwent chemical cauterization. Hemostasis was achieved with concurrent electrocautery in 3 patients who did not respond to chemical cauterization. On follow-up, 5 patients who underwent chemical cauterization underwent with recurrent hemorrhage, second chemical cauterization was successful in these patients in whom mild bleeding focuses were detected. Although hemostasis was achieved in the first application in 66 patients who underwent electrocauterization, recurrent epistaxis occured in 12 patients on follow-up. Chemical cauterization was applied to 2 of these patients because of mild hemorrhage, electrocauterization was applied again to the other 2 because of more severe hemorrhage. Bivalve septal teflon splint was utilized instead of a second electrocauterization in 8 patients receiving anticoagulant treatment because of recurrent epistaxis and bleeding control was achieved.
Conclusion: The outcomes of this study indicated that cauterization was an effective method in treatment of patients with selected anterior septal epistaxis. Chemical cauterization is a practical method that can be the first choice in superficial mucosal bleedings in a limited area. Electrocauterization can be preferred in high volume epistaxis and when prominent vascular structures are seen.
Keywords : Epistaxis, chemical cauterization, electrocauterization, silver nitrate and cauterization