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Challenges in Managing Intractable Epistaxis in a Post-nasal Surgery and Radiated Cancer Patient: A Case Report and
S P Goh1,2,3, Rebecca Wilfred1,2, Salina Husain1
1Department of Otorhinolaryngology Head & Neck Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia.
Summary
Recurrent epistaxis in head and neck cancer survivors can signal serious issues like carotid blowout syndrome. Early diagnosis and tailored management, even when imaging is inconclusive, are crucial for patient outcomes.
Area of Science:
- Otolaryngology
- Head and Neck Surgery
- Vascular Surgery
Background:
- Recurrent epistaxis is a concerning symptom, particularly in patients with a history of head and neck malignancy.
- Life-threatening conditions such as pseudoaneurysm or tumor recurrence must be considered.
- Nasal endoscopy and radio imaging are key diagnostic tools, but may not always identify the bleeding source.
Purpose of the Study:
- To report a case of recurrent epistaxis due to carotid blowout syndrome in a patient with treated sphenoidal sinus squamous cell carcinoma.
- To emphasize the importance of intraoperative examination when imaging is inconclusive.
- To discuss management strategies for carotid blowout syndrome.
Main Methods:
- A patient with a history of head and neck cancer presented with severe epistaxis.
- Standard imaging (angiogram, MRI) failed to identify the bleeding source.
- Examination under general anesthesia led to the diagnosis of carotid blowout syndrome.
- Temporary hemostasis was achieved with a muscular patch and vascular stent insertion.
Main Results:
- Carotid blowout syndrome was diagnosed intraoperatively.
- Bleeding was temporarily controlled during the procedure.
- The patient's condition required tailored management based on their medical status.
Conclusions:
- Examination under general anesthesia is vital when clinical findings contradict imaging results in cases of severe epistaxis.
- Prompt diagnosis and appropriate management of carotid blowout syndrome are essential to prevent severe complications.
- Individualized treatment plans are necessary for managing carotid blowout syndrome.
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