Mixed Type Haemangioma of the Inferior Turbinate: A Rare Cause of Epistaxis

Abstract

Haemangiomas of the nasal cavity are rare benign tumours which usually arise in the Kiesselbach triangle of the septum. Mostly they are seen in young population with peak age 20 years. Epistaxis is the most common symptom in these patients. We present a case of a 62-year-old woman with recurrent epistaxis. On examination she had had an obstruction of both nasal cavities. Computed tomography imaging demonstrated a well-defined tumour originating from the posterior tip of the right inferior turbinate, passing into the nasopharynx. The tumour was managed via endoscopic endonasal approach. The histological analysis revealed a tumour tissue with the appearance of a cavernous haemangioma as well as capillary haemangioma. A focus of intravascular endothelial papillary hyperplasia was also observed. In patients with endonasal benign tumours choice of surgical approach depends on the exact location of the tumour and suspected pathology. The transnasal endoscopic approach and bipolar cautery resection enable adequate exposure and visualization of the tumour, control of bleeding and complete removal of the tumour.

A Patient of Venous Hemangioma of the Inferior Turbinate

“…The transnasal approach using endoscope and adequate cauterization device such as bipolar cautery device, provides visualization of the tumor including its origin and extent, adequate hemostasis, and complete removal of the tumor. 7 In our case, the venous hemangioma was surgically removed, and there has been no signs of recurrence of the tumor.…”

“…Most nonmalignant lesions have characteristic appearances, but definitive diagnosis is achieved with biopsy or culture Imaging techniques such as computerized tomography scan and magnetic resonance scan will reveal anatomic localization and extension of the tumor. 5,7,8 If the lesion is small, excisional biopsy itself is often curative. 5 Most venous hemangiomas are treated by complete surgical excision because these tumors are typically large and do not regress.…”

“…There were no symptoms of nasal obstruction, which might be due the small size of the mass. Most nonmalignant lesions have characteristic appearances, but definitive diagnosis is achieved with biopsy or culture Imaging techniques such as computerized tomography scan and magnetic resonance scan will reveal anatomic localization and extension of the tumor 5,7,8. If the lesion is small, excisional biopsy itself is often curative 5…”

“…Surgery should be based on suspected pathology if not pathologic diagnosis before the surgery as the removal of hemangioma requires adequate hemostasis. The transnasal approach using endoscope and adequate cauterization device such as bipolar cautery device, provides visualization of the tumor including its origin and extent, adequate hemostasis, and complete removal of the tumor 7…”

“…5,6 Known risk factors of PCF include preoperative radiotherapy, chemoradiotherapy, underlying systemic diseases such as diabetes, low hemoglobin level, low postoperative albumin level, large primary tumor size, and extensive operation. [6][7][8] To the best of our knowledge, delayed PCF caused by ACS fixation has not been reported yet. Here we report the first case of delayed PCF caused by a previously inserted ACS fixation plate more than a decade ago in a 70-year-old man.…”