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How safe is submucosal diathermy?
D J Premachandra1, T R Bull, I S Mackay
1Blond McIndoe Centre for Medical Research, Queen Victoria Hospital, East Grinstead, Sussex.
The Journal of Laryngology and Otology
|May 1, 1990
Summary
Submucosal diathermy (SMD) for nasal airway improvement can lead to severe nosebleeds (epistaxis). This case highlights a rare but serious complication requiring significant blood product transfusions.
Area of Science:
- Otolaryngology
- Surgical Complications
Background:
- Submucosal diathermy (SMD) is a widely used endoscopic surgical technique to improve nasal airflow.
- The procedure aims to reduce turbinate tissue, thereby enhancing nasal patency.
Observation:
- A patient undergoing SMD for nasal airway obstruction experienced severe, persistent epistaxis post-operatively.
- The bleeding was profuse and life-threatening, necessitating urgent medical intervention.
Findings:
- The patient required substantial blood product replacement, including 28 units of packed red blood cells, eight units of fresh frozen plasma (FFP), and four units of platelets.
- These transfusions were administered over a 14-day period to manage the ongoing hemorrhage.
Implications:
- This case underscores the potential for significant post-operative epistaxis following submucosal diathermy.
- Clinicians should be vigilant for this rare complication and prepared for aggressive management, including massive transfusion protocols.
- Further research into risk factors and preventative strategies for SMD-associated epistaxis is warranted.