Control of epistaxis, complex, bilateral, with KTP/YAG laser.
John Doe, MD
ANESTHESIA: General endotracheal anesthesia.
ESTIMATED BLOOD LOSS: 10 mL.
FINDINGS: Multiple telangiectasias bilaterally on the septum and the floor of the nasal cavity. These were controlled with KTP/YAG laser.
DESCRIPTION OF PROCEDURE: The patient was taken to the operating room and was placed in the supine position on the operating room table. General facemask anesthesia was given until a deep plane of anesthesia was obtained. At that point, an endotracheal tube was placed by the anesthesiology service without difficulty. Afrin-soaked nasal pledgets were then placed in the nares bilaterally. After allowing time for anesthesia and decongestion, the surgery began with 0-degree nasal endoscope in the right nasal cavity. There were several superficial vessels in the anterior-posterior nasal cavity along the floor. There were also telangiectasias along the septal wall. The KTP/YAG laser under endoscopic guidance was used at 2 watts for cauterization of these multiple telangiectasias and small superficial vessels. The right nasal cavity was then thoroughly irrigated with normal saline and suctioned clear. There was no evidence of epistaxis. Attention was then turned towards the left nasal cavity. Again, this was viewed with 0-degree nasal endoscope. This provided visualization of several small telangiectasias along the septum. There was a small septal perforation. Anterior septal perforation appeared to be a small venous lake, approximately 0.5 mm. There were several small superficial vessels along the floor of the left nasal cavity, bilateral walls. KTP/YAG laser again was used under endoscopic guidance for cauterization of the multiple superficial vessels and telangiectasias. This was also used to control to cauterize the small venous lake anterior to septal perforation. Small area of granulation tissue along the floor of the nasal cavity was visualized with a 45-degree nasal endoscope and cauterized with KTP/YAG laser. The left nasal cavity was then thoroughly irrigated with warm normal saline. There was small evidence of bleeding from the middle turbinate. It was abraded with the endoscope. This was cauterized with suction Bovie cautery. Again, both nasal cavities were thoroughly irrigated with warm normal saline and suctioned. There was no evidence of bleeding. At that point, the procedure was terminated. The patient was then awoken from general anesthesia, extubated and sent to postanesthesia care unit.