Management of severe epistaxis after Young's procedure: a case report

Abstract

We report a case of significant, life-threatening epistaxis following a modified Young's procedure that requiring multiple transfusions, bilateral embolization, and ultimately reversal of the Young's procedure for control of epistaxis. Although recognized as a potential complication, to our knowledge this is the first report in the English literature of such a case.

Complications from office sclerotherapy for epistaxis due to hereditary hemorrhagic telangiectasia (HHT or Osler‐Weber‐Rendu)

“…Conventional therapies used in the management of HHT‐related epistaxis, such as laser coagulation, septodermoplasty, selective arterial embolization, and Young's occlusion, each have specific associated complications, including worsened epistaxis, septal perforation, foul odor, nasal crusting, and compromised nasal breathing . Moreover, intranasal Bevacizumab is also a promising treatment option but presents the potential for impaired wound healing in the context of an otherwise unproven side‐effect profile …”

“…However, it has been long hypothesized and has been recently reported that management of epistaxis in a patient with closed nostril(s) can be exceedingly difficult without reversal of the procedure. In fact, Ting et al . reported a case in which a patient who had previously undergone Young's procedure with initial successful postoperative symptom reduction.…”

“…reported a case in which a patient who had previously undergone Young's procedure with initial successful postoperative symptom reduction. However, she then experienced profuse bleeding into the oropharynx that progressed to bilateral aspiration pneumonia and respiratory compromise …”

Treatment of severe refractory epistaxis in hereditary hemorrhagic telangiectasia using a two‐flap nasal closure method

“…Posterior epistaxis can occur and may be difficult to treat due to loss of access via the nares as reported by the case of a 70 year old woman who required multiple transfusions, intubation, bilateral embolization, and reversal of nasal closure. 19 Thankfully this is rare, and our experience has been nearly immediate cessation of bleeding after the procedure. In addition to discussion of these side effects we recommend a trial of functional closure using petroleum jelly-soaked cotton balls placed in the nares.…”

Hereditary Hemorrhagic Telangiectasia: The ENT point of view

“…The lack of smell and taste was the most frequent complaint. In the literature, there are some isolated cases of bleeding persistent despite the procedure, requiring a reopening of the nasal cavities 51 . In our experience, it is not so easy to convince the patients to undergo the procedure because nasal obstruction is badly supported.…”