[Haemorrhage and haemostasis in face, visceral cranium, neck and middle ear region (author's transl)]

Blutungen im HNO-Bereich

Otolaryngological bleeding is a highly dangerous condition because it is frequently located close to the upper airways. Additionally, it is often unexpected, especially in children, and can injure important nervous structures of the craniocervical region. Over the years, a broad spectrum of algorithms, innovative technologies and therapeutic options have been developed to reduce the incidence of hemorrhages and improve therapy. Nowadays, close cooperation with an hemostaseologist, anesthesiologist and interventional radiologist is necessary for finding the best strategies for the management of bleeding disorders and vascular lesions. This interdisciplinary dialog, combined with an intimate knowledge of the specific otolaryngological techniques, is the precondition for finding an adequate therapy and fulfilling the increasing medico-judicial and economic requirements. We present an overview of the actual and proved concepts for the management of hemorrhage in order to enable the reader to optimize treatment, to increase safety and comfort for the bleeding patient, and to fulfill the medico-judicial and economic requirements.

Curving and looping of the internal carotid artery in relation to the pharynx: frequency, embryology and clinical implications

Variations of the course of the internal carotid artery in the parapharyngeal space and their frequency were studied in order to determine possible risks for acute haemorrhage during pharyngeal surgery and traumatic events, as well as their possible relevance to cerebrovascular disease. The course of the internal carotid artery showed no curvature in 191 cases, but in 74 cases it had a medial, lateral or ventrocaudal curve, and 17 preparations showed kinking (12) or coiling (5) out of a total of 265 dissected carotid sheaths and 17 corrosion vascular casts. In 6 cases of kinking and 2 of coiling, the internal carotid artery was located in direct contact with the tonsillar fossa. No significant sex differences were found. Variations of the internal carotid artery leading to direct contact with the pharyngeal wall are likely to be of great clinical relevance in view of the large number of routine procedures performed. Whereas coiling is ascribed to embryological causes, curving is related to ageing and kinking is thought to be exacerbated by arteriosclerosis or fibromuscular dysplasia with advancing age and may therefore be of significance in relation to the occurrence of cerebrovascular symptoms.