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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.

Insights

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.

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