Epistaxis

Clinical case:Epistaxis Control
Laser used:Epic-S Diode Laser 940 nm
Accessory used:400 um bare fiber tip, non-initiated, clear tip, 30mm long
Surgery handpiece
Treatment parameters:3 Watt CW
Non-contact ablation with clear (white) tip
Authored by physician:Yosef Krespi, MD
Professor of Otolaryngology, Hofstra School of Medicine, New York

Patient symptoms:

Unilateral generally, nasal bleeding. May cause anemia when prolonged. More often in winter time or when dry conditions occur.

Diagnosis:

Treatment with laser is not for the acute phase. Engorged blood vessels generally in Kiesselbach`s area of anterior septum, on the bleeding side with possible ulceration, but can occur on any site including nasal turbinates.

Management:

Vessel sealing can be attempted with the laser when no active bleeding is seen. The laser will ablate the prominent vasculature in the non contact mode. Power is minimal and delivered with short tip with un-initiated tip. The treated area will bleach and vessels involute.

Laser surgery, Pre-Op:

Anesthesia is achieved with a topical application of a mixture of lidocaine 2% and neosynephrine, followed by injection of 2% lidocaine with epinephrine 1:100,000. Sublabial injection may be necessary.

Post-Op:

Bacitracin is applied and patient is advised to apply topical ointment for lubrication for several days.

BEFORE
AFTER

Tip:

Do not ablate vessels bilaterally in one session in order to prevent perforation.

CAUTION
The laser treatment parameters above are provided as a guide and are based on results published or reported by physicians with experience in this indication. Individual treatment should be based on clinical training, clinical observation of laser-tissue interaction, appropriate clinical endpoints and each physician’s own medical judgment.