Massive pneumocephalus following Merocel nasal tamponade for epistaxis

Anterior epistaxis is commonly treated with Merocel nasal tampon insertion in preference to gauze packing. An 89-year-old patient was found to have cerebrospinal fluid rhinorrhea and massive pneumocephalus immediately after removal of a Merocel tampon used for spontaneous anterior epistaxis. She later developed fever and mild confusion, but was well at three-month follow-up. The advantages and complications of Merocel nasal tamponade are briefly reviewed and compared with those of other methods of control of anterior epistaxis.