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Indications for interventional arteriography in post-tonsillectomy hemorrhage.
1Department of Ororhinolaryngology--Plastic Head and Neck Surgery, St Anna Hospital, Duisburg, Germany.
The Journal of Otolaryngology
|March 8, 2002
Summary
Post-tonsillectomy hemorrhage (PTH) occurred in 2.65% of patients, with surgical intervention required in 145 cases. Ligation of the external carotid artery (ECA) was performed in 5 patients, but recurrence necessitated further investigation and treatment.
Area of Science:
- Otolaryngology
- Vascular Surgery
- Medical Device Technology
Background:
- Post-tonsillectomy hemorrhage (PTH) is a significant complication.
- Understanding the incidence and management of PTH is crucial for patient safety.
Observation:
- A retrospective chart review of 5,539 patients identified an incidence of 2.65% for PTH requiring surgical treatment.
- 153 surgical procedures were needed for 145 patients due to recurrent bleeding.
- One lethal outcome (0.018%) and five cases of external carotid artery (ECA) ligation (0.09%) were recorded.
Findings:
- Massive bleeding led to ECA ligation in 5 patients, with recurrence in 3 cases, particularly those operated on elsewhere.
- Arteriography revealed unusual arterial supply from the internal carotid artery (ICA) or carotid bulb in 2 patients post-ECA ligation.
- The study highlights the importance of thorough vascular assessment before ECA ligation.
Implications:
- Complete dissection of the ICA, ECA, and carotid bulb is recommended before ECA ligation to identify vascular abnormalities.
- Immediate arteriography and selective embolization are advised for persistent bleeding or unclear vascular supply post-ECA ligation.
- This approach may offer a less mutilating alternative to ECA ligation.