Cauterization of the maxillary sinuses with a laser. Methods of cauterization of vessels in the nasal cavity. Video: Treatment of ENT diseases with a surgical laser

Otolaryngology is medical specialty which combines both therapeutic and surgical focus. In the course of the treatment of pathologies of the nasal region, various ways impact. The method of cauterization of the nasal mucosa is intended to stop nosebleeds, and can be prescribed for different forms rhinitis. The appropriateness of its use is determined by the attending physician, depending on the clinical situation. Numerous options can be applied to the cauterization procedure. chemical substances(in particular, silver nitrate), as well as laser radiation. How is cauterization of the nasal mucosa performed? Is there a risk undesirable consequences? The patient should be aware of the advantages and disadvantages of the method.

Cauterization method

Cauterization is also called coagulation or cauterization. The method combines many techniques, the difference between which lies in the method of execution and the means used for this. It is applied:

with persistent, often recurring nosebleeds;
with vasomotor rhinitis;
with medical rhinitis;
with chronic hypertrophic rhinitis.

Clinical situations in which nose bleed are quite varied. Cauterization of the nose is one of the most effective methods of treatment, performed by an ENT doctor (otolaryngologist). The essence of the procedure is a chemical or thermal effect on the mucous membrane, which leads to the closure (clogging) of blood vessels and the cessation of bleeding.

The choice of cauterization method depends on pathological changes identified during the survey. Cauterization with silver is an alternative to outdated methods of mucosal sclerosis. Sclerosing agents cause dryness and crusting, which increases the risk of a recurrence of a bleeding episode, aggravates the symptoms of rhinitis.

Are there any benefits to cauterization? Experts indicate several advantages of the method, which determine its widespread use in various options pathologies:

Possibility of local influence.
Fast recovery after the event.
No need for anesthesia.

Cauterization of the vessels of the nose - painful procedure. Since the manipulations performed by the doctor cause pain, anesthesia will be required. The use of drugs belonging to the group of local anesthetics is associated with the risk of an allergic reaction. If you are allergic to any medications, you should tell your doctor about it in advance - this way you can reduce the likelihood adverse effects procedures.

When is cauterization of blood vessels in the nose performed with silver? This variant of cauterization is indicated for nosebleeds from the anterior sections. The severity of bleeding matters - the procedure is effective with its low intensity.

Manipulations are carried out in stages:

anemization of the nasal mucosa;
anesthesia (anesthesia);
spot cauterization with a solution of silver nitrate.

Anemization is performed in order to narrow the vessels of the nasal mucosa. This reduces the amount of discharge and simplifies the procedure. The cauterizing substance does not spread, which allows you to control the boundaries of exposure. applied to the mucous membrane medicinal product(Adrenaline, Ephedrine, etc.), which is administered by spraying or smearing. Anesthesia is carried out with the help of local anesthetics (for example, Lidocaine).

The concentration of the silver solution can be different. For point exposure, a strong solution is suitable (from 40 to 50%). A modern transformation of the silver cautery technique is the use of a cauterizing agent not in the bleeding area, but around it. Since the application of silver nitrate directly to the bleeding site can cause damage and increase bleeding, the “environment” technique problem area allows you to get the best result.

What can be encountered after silver cauterization of the nasal mucosa is performed? Some patients complain of burning, sneezing and watery eyes after the procedure. Many people are concerned about nasal congestion. Although these are temporary phenomena, it is necessary to clarify the likelihood of their implementation with the attending physician, along with ways to eliminate them.

Cauterization with silver cannot be called a gentle method. Sometimes the procedure is advised as a component of the treatment of rhinitis. various etiologies. However, cauterization is not always necessary and can often be replaced alternative ways alleviate the patient's condition. During the procedure, there is a possibility of injury to healthy tissues, so the effect on the mucous membrane with silver nitrate should be justified.

Cauterization of blood vessels in the nose with silver is prohibited in case of hemorrhagic diathesis.

Hemorrhagic diathesis is a group of pathologies that are manifested by a tendency to increased bleeding. Tissue damage during chemical coagulation leads to an increased risk of recurrent nosebleeds - and it can be profuse, as the boundaries of the affected area become wider.

Cauterization of blood vessels in the nose with a laser can be effective in chronic nosebleeds, various types of rhinitis (in particular, with drug-induced rhinitis developed as a result long-term use vasoconstrictor nasal drops). This manipulation is considered as a kind of surgical intervention, which requires careful justification of the indications.

How are the vessels in the nose cauterized? First, local application anesthesia(Lidocaine, Adrenaline). In the area of intervention, the necessary manipulations are carried out using laser radiation. Coagulation is carried out along the perimeter of the intended area, then the “problem focus” is directly coagulated.

The operation can be performed on an outpatient basis, does not require hospitalization and long recovery. Laser cautery nasal mucosa helps to eliminate congestion when chronic course rhinitis, prevent recurrence of bleeding. After the procedure is completed, the patient is prescribed ointments (Actovegin, Solcoseryl, Traumeel C).

In chronic hypertrophic rhinitis, cauterization of the nasal mucosa with a laser is only one of the possible methods of treatment. The advantage of laser radiation is the sterility of the intervention, fast healing area of influence.

What to do after cauterization in the nose? There are several recommendations that are relevant for patients undergoing a cauterization procedure:

You can't be stressed.
You can't blow your nose.
It is forbidden to remove the crusts yourself.

Within a few days after the procedure, you need to use vaseline or sea buckthorn oil. Im impregnated cotton swabs, which are then inserted into nasal cavity 2 to 3 times a day. The doctor may recommend other medicines.

Cauterization should be unilateral.

If cauterization is required, it is recommended to simultaneously carry out the procedure on only one side, otherwise there is a risk traumatic injury in particular, perforation of the nasal septum. If there are pathological foci in both halves of the nasal cavity, a repetition of cauterization is indicated a few days (from 5 to 8) after the first episode of intervention.

Cauterization of the capillaries in the nose allows short time solve the problem of nosebleeds. However, each method of cautery has its own characteristics that must be taken into account. Only a doctor can recommend the procedure, based on the data of an objective examination and the results of an additional examination.

Is it true that from chronic rhinitis help get rid of cauterization of the nasal mucosa? This question is asked quite often by those who cannot do without permanent use vasoconstrictor drops and sprays, especially in the autumn-spring period. Concerned about ENT patients and safety surgical methods treatment of chronic rhinitis and the widespread opinion about the harmfulness of nasal sprays and drops.

Are nasal drops really harmful?

Nasal addiction medicines really noted by all otolaryngologists. Starting to use them severe runny nose a person can become addicted.

Everything is explained by the structure of the turbinates: they are penetrated by many small blood vessels, which normally do not bother a person. At viral infection, dusty air or the presence of some impurities in it, the vessels in the nose expand, the porous tissue increases in volume and secretes mucus. Its main function is to protect the lungs from dust and impurities by binding them. And with an infection, a certain number of pathogens are excreted in this way. The process is natural, but the swelling of the turbinates makes it difficult to breathe through the nose, and the secretion of mucus creates the need to blow your nose and worries the person. With ARVI, difficult outflow and retention of contents in maxillary sinuses ah can cause u joining secondary infection, which leads to complications in the form of sinusitis, sinusitis, etc.

To reduce these phenomena, a number of drugs are used in the form of drops and sprays: naphthyzine, sanorin, galazolin, ephedrine and others. Getting on the edematous nasal mucosa, they penetrate into the blood and have an effect on the body similar to adrenaline, that is, they narrow the lumen of the blood vessels. But their action is limited to 2-2.5 hours, after which breathing through the nose again becomes difficult.

Doctors recommend using such drugs for no more than 5-6 days in a row during an illness. Habituation for such a period does not occur or passes very imperceptibly. Those who begin to use nasal sprays constantly, at the slightest nasal congestion, acquire not only physiological, but psychological dependence from the drug. There are even cases when a person, suddenly remembering a forgotten bottle of medicine, immediately begins to feel the symptoms of a severe cold.

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How to cure a chronic runny nose and part with the spray?

How effective treatment chronic rhinitis without dependence on the drug for a long time cauterization of the mucosa with silver nitrate was used. This procedure is quite unpleasant and traumatic, so it is increasingly being replaced by more modern methods:

submucosal vasotomy;
conchotomy;
electrocoagulation;
cryodestruction;
coblation.

Submucosal vasotomy and conchotomy are most commonly referred to as laser cautery. In the first case we are talking about to destroy the mucous membrane and stop the capillaries that supply blood to the cavernous bodies of the turbinates. This procedure continues for about 5 minutes under local anesthesia. The operation is less traumatic, recovery after it takes place within a few days and does not require hospitalization. The doctor can cauterize the mucous membrane with a laser beam or a beam of radio waves, depending on the methodology adopted in this clinic.

Conchotomy is the removal of the mucous membrane (in whole or in part) using a cutting tool. This operation is carried out in a stationary general anesthesia and takes a lot of time to recover.

A modern variation is cauterization of the nasal passages with a laser beam. Wherein blood vessels immediately closed, which eliminates the penetration of infection and bleeding during and after surgery. The operation is performed on an outpatient basis local anesthesia and without subsequent hospitalization.

A similar method is the impact on the mucosa of high (electro- and thermocoagulation) and ultra-low (cryodestruction) temperatures and radio waves during coblation.

Cauterization of capillaries and small arterioles in the nasal passages is one of the effective and frequently used methods of therapy. As a rule, it is prescribed to patients with ailments of the vascular structure of the nose, expressed in its incorrect operation and not amenable to conservative treatment.

For the most part, cauterization of vessels is done for people with frequent nosebleeds or suffering from medical rhinitis. We will talk in more detail about this method of therapy, indications for its implementation and the nuances of the procedure today.

Cauterization of vessels in the nose is the informal name for therapeutic procedures called "conchotomy" and "vasotomy". The nature of their implementation is slightly different, but both operations are aimed at changing the functioning of the vascular structures in the nasal cavity. When implementing conchotomy, there is partial removal capillaries and arterioles, with vasotomy - ordinary cauterization of those.

The main purpose for similar procedures are (less often - other problems in the functioning of vascular structures). On the this moment cauterization of vessels in the nasal passages is often carried out with:

hypertension
weakness of capillaries and arterioles
any pathologies affecting the blood coagulation index
high susceptibility to allergies
hormonal problems
the phenomenon of "dryness" of the mucosa due to some external factors(dusty and dry air, poor ecology)
consequences of improper intake of nasal drops

Simply put, cauterization of blood vessels is required for people with improper functioning of the nasal mucosa. To stabilize its functioning, it is necessary to carry out this particular procedure. After external influence and a kind of tissue excision, the vessels will gradually rebuild, normalize the internal tone and the mucous membrane will begin to work in the correct mode.

In any case, both conchotomy and vasotomy are very serious procedures, before which it is important to consult a doctor. Remove if desired persistent bleeding from the nose, you should not forget about it.

Cauterization of blood vessels by laser

cauterize vascular structure nose can different ways. The most used and convenient procedure is considered to be carried out using a laser. Analogues of such vasotomy can be fully considered radiosurgery or exposure to ultrasound, but due to less simplicity, poor comfort in terms of carrying out and overall effect they are practically not used in modern medicine. The laser has completely replaced them.

Laser vasotomy - truly unique procedure. It is implemented both at the front and at back bleeding. This is due to the excellent effect of the laser on both small vessels and rather large arterioles, which often “burst” during posterior nosebleeds. There are no particular difficulties in cauterizing blood vessels with a laser.

To carry out the procedure without excesses and with greatest effect, enough:

Refer to professional doctor and complete the required research.
Listen carefully to the preoperative recommendations of the doctor.
Unquestioningly follow his instructions directly during vasotomy.

The operation itself is carried out in several stages:

The operated patient sits down on a special chair in comfortable position and fixes the head without movement.
After that, the specialist conducting the procedure adjusts the laser device for the patient, taking into account the severity of his problem and individual characteristics.

From the video you can find out how laser vasotomy works:

Then cauterization is implemented directly. For this:

The patient is prohibited from moving and given recommendations on breathing technique for the duration of the operation.
Special forceps fix his nose and open his nostrils.
A laser tube is inserted to the required depth and cauterization of the vessels is performed.

Laser vasotomy does not cause significant discomfort or pain to a person, which is why it is performed without anesthesia. The duration of the procedure rarely exceeds 1-1.5 hours with all the preparatory and consulting moments. Surprisingly, a rather simple or even primitive operation gives a significant and quick effect, facilitating the elimination of patient problems in a convenient way.

Cauterization with silver

Specific, but also very simple and effective way cauterization is vasotomy with silver, or rather, its nitrate.

A special solution based on this substance is able to have a moderate effect on the mucous membrane, helping to eliminate the problem with the vessels, moreover, without causing any discomfort to the person.

Cauterization with silver is implemented in an even simpler mode, namely:

The patient is dressed in protective clothing and sits down on a chair-couch.
Next, the doctor conducts the necessary consultations with him and prepares a solution for application to the affected areas of the mucosa.
After that, in a gentle mode, silver nitrate is applied in the nasal passages.

As soon as the applied solution has dried up and formed a specific crust, the patient is no longer detained and is allowed to go home. After 2-3 days, this crust will fall off and disappear from the nasal cavities on its own. Naturally, the vessels will already be cauterized and will begin to recover over time.

There are no special features in silver vasotomy. The main thing is to act according to the doctor's recommendations and avoid getting the nitrate substance on the skin or clothes. The fact is that spots form at the site of contact with the solution. If they disappear from the skin in a couple of days without leaving a trace, then any clothes will certainly deteriorate.

Operation prognosis and possible complications

Cauterization of blood vessels in the nose is a completely ordinary and primitive procedure in modern medicine. There are no peculiarities and difficulties in its implementation, so the prognosis of the operation is always favorable.

The lack of proper effect is extremely rare and is usually associated with the lack of professionalism of doctors or the severity of the damage to the nasal mucosa in humans.

As for complications after vasotomy, they are very rare. People who have carried out cauterization of blood vessels in the nose sometimes complain about:

a long period of tissue repair, which is accompanied by slight pain or other discomfort
lack of proper effect or even increased bleeding
an allergic reaction caused by medications and solutions used during the operation

When working with a real professional, the lack of effect from vasotomy, and even more so the development of complications, is practically excluded. If their appearance could not be avoided, it is necessary to re-contact the doctor, undergo a simple diagnosis and eliminate the existing problems. As a rule, such manipulations do not take much time, and after reoperation or other procedures, the human condition is normalized.

Rehabilitation

Rehabilitation is an important period after a vasotomy, since the success of the entire procedure largely depends on it. To obtain maximum effect from surgery and minimize the risks of complications, it is enough to adhere to all rehabilitation recommendations the doctors. It is often necessary:

For 2-4 weeks, refuse to take any drugs that affect the vessels in the nose and, accordingly, its mucous membrane.
Do not visit baths, saunas and other places with abnormally high temperatures.
Do not drink alcohol for 2-3 weeks.
Do not act on operated tissues.
Carefully monitor your condition and if the slightest deviations from the norm appear, contact the observing specialist.

Basically, nothing more rehabilitation period not required. The main thing is to follow a competent recovery procedure.

Contraindications to all types of cauterization

Cauterization in the nose of any kind has a small number of contraindications. Vasotomy should be avoided only if one of the following factors is present:

pregnancy or lactation
course of acute infectious pathologies for the duration of the operation
exacerbation of ENT diseases that have a chronic form
the presence of high risks hemorrhagic shock(eg, common in people with low blood platelets)
serious illness psychosomatic nature making it impossible for a person to stay in a stationary position for some time

In the case of vasotomy with silver, it is also important to exclude the presence of an allergy in the operated person to the nitrate of this substance. Similar allergic reaction- of course, a rarity, but still it takes place and requires mandatory accounting before the operation. Otherwise, there are no prohibitions on cauterization of blood vessels in the nose, regardless of the type of procedure performed.

At the end of today's article, let's pay attention to the main advantages and disadvantages of vasotomy. Let's start with the advantages of the operation:

Slight damage to the tissues of the nasal passages during its implementation.
Almost guaranteed effect.
Absence of scars, bleeding wounds and similar defects after the procedure.
The impossibility of infection of the patient during vasotomy.
Carrying out without anesthesia.
Simplicity, in some way the primitiveness of the procedure, which does not require any preparation or complex manipulations for implementation.

As for the disadvantages of vasotomy, only two provisions are distinguished among them:

First, it's not free. For the operation, you will need to contact the appropriate medical institutions, since it is not carried out under the policy in city hospitals.
Secondly, there is a small list of contraindications. Although it is not great, it is still there and makes vasotomy not always possible.

In principle, on this note, the most important provisions on the procedure for cauterization of blood vessels in the nose came to an end. As you can see, this type of operation is not complicated in terms of implementation and preparation. For its successful implementation, it is enough to adhere to the provisions discussed above. We hope that the presented material was useful for you and gave answers to your questions.

Cauterization of blood vessels in the nose is a simple operation that is performed in case of frequent bleeding or chronic rhinitis. This method removes all unpleasant symptoms and quickly restore breathing. Modern surgery offers a number of minimally invasive manipulations, thanks to which the patient quickly recovers after cauterization and can immediately return to his usual way of life. The technique is selected individually, taking into account the patient's condition, age and diagnosis.

Indications for the operation

Despite the fact that cauterization of vessels is considered a simple and safe intervention, it is prescribed only if conservative treatment turns out to be ineffective. In most cases, the procedure is performed to stop nosebleeds. They occur if small blood vessels are located close to the surface of the mucous membrane, and their walls are not strong enough. At the slightest impact or increase in pressure, they are injured, so medication treatment does not work.

Other indications for cauterization of blood vessels may be:

chronic rhinitis, persistent inflammation nasal mucosa;
atrophic changes in the mucosa;
persistent shortness of breath, nasal congestion;
inflammation of blood vessels and expansion of their lumen.

REFERENCE! When one or more indications appear, an operation is definitely recommended for adults. It is simple, goes without complications and side effects. However, the weakness of the vascular walls in children can be temporary and disappears with age.

Methods of cauterization of vessels

The main purpose of the procedure is to stop blood circulation in small capillaries located in the thickness of the nasal mucosa. This can be done in several ways: mechanically or chemically, by the action of laser radiation or electricity, low temperatures. The technique is selected depending on the size of the vessel and its location and distance, as well as the size of the nasal passages. All methods of cauterization have a number of advantages over conservative treatment:

point impact only on the necessary area, without damaging the surrounding tissues;
minimal risk of recurrence of nosebleeds;
quick and easy recovery period, carried out at home;
The procedure is performed under local anesthesia.

Each cauterization method has its own advantages and disadvantages. The patient may be offered several options, in which case one of the main selection criteria is the cost of the procedure.

Cauterization with silver nitrate

Chemical cauterization of the vessels of the nose is classical technique. It is carried out by combining silver nitrate in combination with chromic anhydride and trichloroacetic acid. The mixture is applied to small areas in the front of the nose. The method is considered the most imperfect and has a large number of shortcomings. The contact of chemical reagents with the mucous membrane is accompanied by painful sensations. They can be applied only with minor bleeding, while only on asymmetrical areas. Otherwise, there is a risk of formation of synechia - pathological dense growths from connective tissue, which form a kind of jumper.

Frequent nosebleeds that cannot be stopped conservative methods, - the main indication for cauterization of vessels

Using a laser

The operation to cauterize blood vessels with a laser lasts no more than 30 minutes. This period also includes local anesthetic, which begins a few minutes after its application. The patient then takes horizontal position, and the surgeon acts on certain vessels with a special apparatus. laser radiation directed to small areas, acts pointwise and does not affect healthy tissues of the mucous membrane. Postoperative period lasts no more than a few hours, after which the patient does not need to stay in the hospital.

During the procedure laser ray stops blood circulation in a certain vessel. A thin film forms on the damaged area. It protects tissues from pathogenic microflora and prevents the development of complications. Improvements become noticeable after the first cauterization session. However, some patients may need multiple treatments if a large number of small vessels need to be cauterized.

Electrocoagulation

Thermocoagulation (electrocoagulation) is a method of cauterization of blood vessels using constant electric current. A voltage electrode is inserted under the nasal mucosa, which is heated to high temperatures. This causes tissue destruction and burns. Over time, it heals, but blood circulation in the injured area does not resume. In addition, the use of devices that are a source of electric current protects the postoperative wound from bacteria. At high temperatures, bleeding quickly stops with the formation of a protective film (crust). Under it, new healthy tissue grows.

Mechanical and chemical methods cauterization is practically not used, but continues to exist, due to the low cost

Radio wave coagulation

This method is similar to electrocoagulation. The mucous membrane is exposed to the point action of the electrode with alternating current. It causes heating of tissues and their destruction, which causes the cessation of blood flow through the vessels. The difference between the two methods lies in the characteristics of the apparatus. With electrocoagulation, the area that is in contact with the probe is heated, with radio wave coagulation, the tissue around it is heated.

Cryocoagulation with liquid nitrogen

Cryocoagulation, unlike other methods, is based on the influence of low temperatures. With the help of a cryoprobe, it is delivered to a certain area a liquid nitrogen. Under its influence, tissue destruction occurs, and blood circulation stops in the vessels. The positive features of the method are its safety and minimal invasiveness. All structures remain intact, the functions of the organ are not violated. Low temperatures affect the composition of the blood. It becomes thick, forms blood clots and stops moving through the vessels. The duration of the procedure does not exceed a few minutes, but the course consists of at least 2-3 sessions. On the third day after the end of treatment with liquid nitrogen, a thick mucous secret begins to stand out. it normal phenomenon, which indicates the processes of tissue regeneration.

Using the Radio Knife

The radiosurgical knife is a relatively new invention. The principle of its action is based on the dissection of tissues and cauterization of the edges of the wound. It is used to perform operations of any level of complexity. During the intervention, there is no blood loss, and high temperatures have an additional bactericidal effect. A significant drawback of the method is its high cost.

Mechanical techniques

The cessation of blood circulation through the vessels by mechanical means is practically not used. They are characterized by a high degree of invasiveness, significant blood loss and the risk of contamination. bacterial infection. In addition, to obtain online access, it may not be enough local anesthesia- General anesthesia is required. There are several known methods that can be used to stop nosebleeds:

cutting nasal loop - a tool for removing part of the nasal concha in order to facilitate breathing;
lateralization - a fracture of the nasal concha and its displacement to the lateral part, as a result of which the volume of incoming air increases significantly.

IMPORTANT! Although mechanical methods bleeding treatment and chronic diseases noses are of low cost, they are practically not in demand. They represent a complete surgical intervention with general anesthesia and a long rehabilitation period, as well as with increased risk postoperative complications.

Recovery after the procedure

Vascular coagulation is not a very complicated procedure, but during the first 1-2 weeks after it, a number of recommendations should be followed. They are aimed at faster tissue healing, preventing bleeding and exacerbations of the disease. Regardless of the chosen method of carrying out the operation, the instructions will be as follows:

avoid visiting baths, saunas, swimming pools, as well as swimming in open and closed water bodies;
stop drinking alcohol;
decrease physical exercise, postpone training and try not to run;
rinse the nose with normal saline or its analogues;
moisturize the mucous membrane with neutral oils (you can use ordinary petroleum jelly or sea buckthorn oil).

It is important to avoid situations that increase the risk of damage to the nose. So, for several days after cauterization, it is forbidden to blow your nose, and nasal exudate can only be removed by washing. Otherwise, the healing time may increase significantly.

After the procedure, the mucous membrane can swell and become inflamed, crusts form on it, so it is important to clean it at home until it is completely healed.

Contraindications for the operation

Each method has its own contraindications. So, before the procedure, it is necessary to exclude the risks of individual sensitivity to the selected drugs for anesthesia, or local anesthesia. In addition, the operation is not performed in the following situations:

persistent hypertension - high blood pressure;
changes in blood viscosity, which causes the formation of blood clots or too slow wound healing;
infectious diseases;
allergic rhinitis.

Immediately before the operation, an examination and radiography of the desired area is mandatory. Contraindications to cauterization of vessels can be nasal injuries (including chronic ones), incorrect position of the nasal septum, inflammatory pathologies, the presence of neoplasms and foreign objects, as well as dryness and damage to the mucous membrane.

Possible Complications

Most of the time, the surgery goes without side effects. If all recommendations are followed, breathing is restored within a week, and the risks of re-exacerbation are minimized. However, some patients may experience the following complications:

increased symptoms of nasal congestion (repeated hypertrophy of the mucous membrane);
a decrease in olfactory function is a temporary phenomenon associated with tissue swelling;
inflammation, including purulent - a consequence of seeding postoperative wound pathogenic microflora;
atrophy of the mucous membrane;
the formation of adhesions - the growth of scar connective tissue.

In most cases, cauterization of vessels becomes very effective method treatment of nosebleeds and chronic rhinitis. Compared with conservative ways these methods are more efficient. When the main cause of the pathology is eliminated, the patient's condition quickly returns to normal, his breathing is restored, vascular walls. However, before the appointment of the operation, you should definitely use medical methods treatment.

At heavy bleeding when conventional methods cannot stop the blood, they resort to cauterization of the bleeding place with various cauterizing agents. First you need to find the bleeding area.

How to detect bleeding

Sometimes the site of bleeding is visible to the naked eye if you lift the tip of your nose. In this case, cauterization is performed not in the depth of the nasal cavity, but at the entrance. Additionally, this head position, which prevents the outflow of blood into the pharynx, has an important advantage - vomiting and swallowing movements stop. This usually contributes complete cessation bleeding.

If it is not possible to quickly identify the place of bleeding, the person needs to blow his nose, thereby clearing the nasal passages of blood clots. The nose is then examined using a nasal speculum. If no bleeding is found in a typical area (Kisselbach's area), a rupture is most likely in the back of the nose. Sometimes the source of bleeding is difficult to establish. In this case, you need to examine a point called tuberculum septi. It is located on the nasal septum. There are large accumulations of cavernous tissue. In about 5-7% of cases, bleeding occurs from here. In young children, it is more difficult to identify the source of bleeding. Adolescents already have fairly wide nasal passages, the source is easily determined, especially if anesthetic solutions and adrenaline (1: 1000) are used.

Cauterization by conventional methods

Once the site of bleeding is found, cauterization is performed to create a scab. Are used various means moxibustion. These are some acids (trichloroacetic, lactic, chromic), alum, silver nitrate solution, zinc salts, tannin. Less often, surgical diathermy or galvanocaustics are used. These methods are not equivalent. They have a different depth of cauterization, so the procedure must be entrusted to specialists.

Weak cauterizing effect of silver nitrate, tannin, zinc. Therefore, the scab is formed superficial. Chromic acid, galvanocaustics and surgical laserthermia create a deep eschar. Cauterization of the nasal septum is allowed from two opposite sides, but in such a way that the zones of influence do not fall against each other. Excess acid on the mucosa is neutralized by 2 percent. soda solution. Scars form in places of cauterization. Quite often after usual cauterization resumption of bleeding is noted. Therefore, it is practiced to cauterize not a bleeding place, but to make a "halo" around it, after which bleeding rarely resumes.

To modern methods stop nosebleeds, and very effective, include laser therapy, ultrasonic disintegration, cryotherapy with liquid nitrogen.

Cauterization by cold

The effect of exposure to liquid nitrogen can also be compared with cauterization. Liquid nitrogen is a colorless, odorless liquid with a temperature of -196 C, not flammable. At room temperature evaporates at a rate of 50 ml/h. Stored in a Dewar vessel (you can use a thermos). To cool the cryoprobe, an exposure of at least 1 min is needed (the end of cooling is determined by the cessation of nitrogen "boiling"). The therapeutic effect of liquid nitrogen is strictly localized and limited to the area that is exposed. It is believed that after exposure to liquid nitrogen, there are no pronounced scars, especially when the tissue is not severely injured.

Cryotherapy can be used both at the time of bleeding and after it has stopped. After local anesthesia (sometimes anesthesia is not performed), the bleeding site is touched or a "halo" is drawn around the bleeding site. In order to exclude the effect of cold on the surrounding tissues of the nasal septum and other nearby unaltered tissues, a special PTFE shield (f-4) worn on the needle can be used. In addition, the jaws of the nasal planum also protect the wings of the nose and other tissues from the effects of cold.

A cryoapplicator with vapor-liquid circulation of nitrogen is also used. Snow carbonic acid (temperature -79 C) can be used as a refrigerant. Cryotherapy with this acid is carried out using an oval spoon (the size of the working part is 4x4 mm) made of polymeric material. It is filled with a lump of low-temperature carbonic acid and applied to the problem area. Exposure to cold is carried out by a single-cycle or two-cycle method. The freezing exposure with a cryoprobe and snowy carbonic acid is 15-30 seconds, with a cryoapplicator 30-120 seconds.

In some cases, after the bleeding area has been frozen, without waiting for it to thaw, it is advisable to perform nasal packing. The need for such a combined method of stopping bleeding may be due to the impossibility of obtaining a direct hemostatic effect from the action of low temperature in some people. Local freezing reduces pain sensitivity to tamponade and creates conditions for stopping bleeding in those patients in whom tamponade or other means of therapeutic effect could not be achieved.

It is important to emphasize that liquid nitrogen does not cause those reactive changes in tissues that are observed after exposure to them with an electrocautery (galvanocautery) or other cauterizing agents. This is especially important in the treatment of children. Many children are afraid of "hot iron" during galvanocaustics and more willingly, without fear, agree to "freeze". The method of local freezing is especially effective in hemorrhagic diathesis in children (Rendu-Osler disease, hemophilia, Werlhof's disease).

AT recent times local exposure began to be used in combination with optical means, since bleeding places, especially in young children, are always very small and difficult to find with the naked eye. It is even more difficult to manipulate in these areas. When using an operating microscope, doctors have bright, deeply penetrating illumination without chiaroscuro, binocular vision and stereoscopic image.