Hemostasis in Head and Neck Surgery, An Issue of Otolaryngologic Clinics of North America, 1e (The Clinics: Surgery)

Hemostasis in Head and Neck Surgery: An Integral Aspect for Optimal Surgical Outcomes

Introduction:

In the realm of head and neck surgery, the management of bleeding poses a crucial challenge that can significantly impact surgical visibility, potentially leading to intraoperative complications and postoperative morbidity. This issue of Otolaryngologic Clinics delves into the complexities of hemostasis in head and neck surgery, providing a comprehensive guide to managing expected bleeding and vascular injury during endoscopic sinus and skull base procedures.

Preoperative Considerations:

To effectively prepare for hemostasis, it is essential to identify patients at high risk for vascular complications. This assessment involves a thorough understanding of the patient’s medical history, including any known bleeding disorders or medications that may affect coagulation. Advanced imaging techniques, such as computed tomography angiography, can also provide invaluable insights into the patient’s vascular anatomy.

Intraoperative Strategies:

During surgery, surgeons must adopt meticulous techniques to minimize bleeding and mitigate vascular injury. Endoscopic visualization plays a pivotal role, allowing for precise identification and management of bleeding points. Hemostatic agents, such as topical vasoconstrictors and absorbable sponges, can be employed to control minor bleeding. For more significant hemorrhage, electrocautery, bipolar coagulation, and laser technologies can be utilized.

Management of Major Vessel Injury:

In the event of major vessel injury, such as an internal carotid artery injury, prompt action is critical. The article presents a comprehensive algorithm for managing such injuries, outlining the steps from initial recognition to definitive intervention. Collaboration between the surgical team, including otolaryngologists, neurosurgeons, interventional radiologists, and neurophysiologists, is essential to ensure optimal patient outcomes.

Role of Interventional Radiology:

Interventional radiology plays an increasingly important role in the management of bleeding in head and neck surgery. Techniques such as embolization and stent placement can be employed to control vascular injury noninvasively, offering minimally invasive alternatives to open surgery.

Pharmacological Management:

Pharmacology plays a complementary role in hemostasis. Tranexamic acid, an antifibrinolytic agent, has been shown to reduce blood loss in skull base surgery. Other medications, such as desmopressin and aminocaproic acid, may also be considered for specific bleeding disorders.

Conclusion:

Hemostasis in head and neck surgery is a complex and multifaceted aspect of surgical practice. This issue of Otolaryngologic Clinics provides a comprehensive overview of the subject, offering practical guidance and cutting-edge insights into the assessment, management, and prevention of bleeding complications. By embracing a multidisciplinary approach that integrates clinical anatomy, physiology, surgical techniques, and pharmacology, surgeons can enhance patient safety and optimize outcomes in head and neck surgery.