Research Article
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The Importance of Nasofrontal Angle in Recurrent Childhood Idiopathic Epistaxis

Year 2019, Volume: 5 Issue: 3, 1788 - 1795, 31.12.2019
https://doi.org/10.30569/adiyamansaglik.638799

Abstract

Aim: Epistaxis is a common, usually self-limiting, clinical
condition in childhood. Many factors have been identified in the etiology of
epistaxis although one third of epistaxis called idiopathic. Anatomical
structure of nose should be taken into account in the evaluation of patients
with recurrent idiopathic epistaxis. Aim of this study to reveal whether or not
there is any correlation between nasofrontal angle and recurrent idiopathic
epistaxis in children.

Methods: The patients referred to the pediatric and ear-nose-throat outpatient
clinics for recurrent epistaxis between October 2014–April 2015 were enrolled
in the study and accepted as study group. The control group was chosen from
patients without epistaxis. The NFA was measured with a commercial angle meter
under normal anatomic position by the same researcher.

Results: Sixty-two subjects with recurrent idiopathic epistaxis and ninety subjects
without epistaxis were enrolled in this study and named as the study group and
the control group, respectively. The mean NFA of the study group was 139.29 ± 6
(125-159)º while the mean NFA of the control group was 133.8 ± 4.8 (123-146)º.
The NFA in the study group was significantly higher than that in the control
group (p<0.001).

Conclusion: Increased NFA can be accepted as one of the abnormalities in the anatomical
structure of the nose in the etiologic classification of epistaxis. More
researches will be needed to identify the importance of NFA for recurrent
idiopathic epistaxis.

Thanks

We are grateful to Ayse Bayram and Esra Bucak for support with the Figure 1.

References

  • References1. Haddad Jr J. Epistaxis. In: Kleigman RM, Stanton BF, St Geme JW, Schor NF, Behrman RE, editors. Nelson Textbook of Pediatrics. Philadelphia: Elsevier Saunders Inc; 2011:1432-3.
  • 2. Bjelakovic B, Bojanovic M, Lukic S, Saranac L, Vukomanovic V, Prijic S, Zivkovic N, Randjelovic D.. The therapeutic efficacy of propranolol in children with recurrent primary epistaxis. Drug Des Devel Ther. 2013;7:127-9.
  • 3. Ahmed AE, Abo El-Magd EA, Hasan GM, El-Asheer OM. A comparative study of propranolol versus silver nitrate cautery in the treatment of recurrent primary epistaxis in children. Adolesc. Health Med Ther. 2015;6:165-70.
  • 4. Varshney S, Saxena RK. Epistaxis: A retrospective clinical study. Indian J Otolaryngol Head Neck Surg. 2005;57(2):125-9.
  • 5. Yau S. An update on epistaxis. Aust Fam Physician. 2015;44(9):653-6.
  • 6. Kodiya AM, Labaran AS, Musa E, Mohammed GM, Ahmad BM. Epistaxis in Kaduna, Nigeria: a review of 101 cases. Afr Health Sci. 2012;12(4):479-82.
  • 7.Wahab M S A, Fathy H, Ismail R, Mahmoud N. Recurrent epistaxis in children: When should we suspect coagulopathy?. The Egyptian Journal of Otolaryngology. 2014;30(2):106-11.
  • 8. Kucik CJ, Clenney T. Management of epistaxis. Am Fam Physician. 2005;71:305-11.
  • 9. Qureishi A, Burton MJ. Interventions for recurrent idiopathic epistaxis (nosebleeds) in children. Cochrane Database Syst Rev. 2012;9:CD004461.
  • 10. Oztürk H, Ipek A, Tan S, Yener Öztürk S, Keskin S, Kurt A, Arslan H. Evaluation of fetal nasofrontal angle in the second trimester in normal pregnancies. J Clin Ultrasound. 2011;39:18-20.
  • 11. Cicero S, Curcio P, Papageorghiou A, Sonek J, Nicolaides K. Absence of nasal bone in fetuses with trisomy 21 at 11-14 weeks of gestation: an observational study. Lancet. 2001;358(9294):1665-7.
  • 12. van der Heijden P, Korsten-Meijer AG, van der Laan BF, Wit HP, Goorhuis-Brouwer SM. Nasal growth and maturation age in adolescents: a systematic review. Arch Otolaryngol Head Neck Surg. 2008;134:1288-93.
  • 13. Song KJ, Lee EJ, Lee JM, Jo GH, Kim KS. The effect of caudal septoplasty on nasal angle parameters: a report on 69 cases. Clin Otolaryngol. 2016;41:185-9.
  • 14. Adams DJ, Clark DA. Common genetic and epigenetic syndromes. Pediatr Clin North Am. 2015;62:411-26.
  • 15. Bernius M, Perlin D. Pediatric ear, nose, and throat emergencies. Pediatr Clin North Am. 2006;53:195-214.
  • 16. Sandoval C, Dong S, Visintainer P, Ozkaynak MF, Jayabose S. Clinical and laboratory features of 178 children with recurrent epistaxis. J Pediatr Hematol Oncol. 2002;24:47-9.
  • 17. Zhou F, Xu Y, Zhang Z, Wu X, Jin R. Severe Hemorrhage in Chinese Children With Immune Thrombocytopenia. J Pediatr Hematol Oncol. 2015;37:e158-61.
  • 18. Kikidis D, Tsioufis K, Papanikolaou V, Zerva K, Hantzakos A. Is epistaxis associated with arterial hypertension? A systematic review of the literature. Eur Arch Otorhinolaryngol. 2014;271:237-43.
  • 19. Comelli I, Vincenti V, Benatti M, Macri GF, Comelli D, Lippi G, Cervellin G. Influence of air temperature variations on incidence of epistaxis. Am J Rhinol Allergy. 2015;29:e175-81.
  • 20. Abou-Elfadl M, Horra A, Abada RL, Mahtar M, Roubal M, Kadiri F. Nasal foreign bodies: Results of a study of 260 cases. Eur Ann Otorhinolaryngol Head Neck Dis. 2015;132:343-6.
  • 21. Murray AB, Milner RA. Allergic rhinitis and recurrent epistaxis in children. Ann Allergy Asthma Immunol. 1995;74:30-3.
  • 22. Petty DA, Blaiss MS. Intranasal corticosteroids topical characteristics: side effects, formulation, and volume. Am J Rhinol Allergy. 2013;27:510-3.
  • 23. Daniel M, Raghavan U. Relation between epistaxis, external nasal deformity, and septal deviation following nasal trauma. Emerg Med J. 2005;22:778-9.
  • 24. O'Reilly BJ, Simpson DC, Dharmeratnam R. Recurrent epistaxis and nasal septal deviation in young adults. Clin Otolaryngol Allied Sci. 1996;21:12-4.
  • 25. Liu T, Han D, Wang J, Tan J, Zang H, Wang T, Li Y, Cui S. Effects of septal deviation on the airflow characteristics: using computational fluid dynamics models. Acta Otolaryngol. 2012;132(3):290-8.
  • 26. Chen XB, Lee HP, Chong VF, Wang de Y. Assessments of nasal bone fracture effects on nasal airflow: A computational fluid dynamics study. Am J Rhinol Allergy. 2011;25:e39-43.
  • 27. Bailie N, Hanna B, Watterson J, Gallagher G. A model of airflow in the nasal cavities: Implications for nasal air conditioning and epistaxis. Am J Rhinol Allergy. 2009;23:244-9.
  • 28. Tezel E, Durmuş FN. A new instrument for achieving a natural nasofrontal angle. J Plast Reconstr Aesthet Surg. 2009;62:e617-9.
  • 29. Uzun A, Akbas H, Bilgic S, Emirzeoglu M, Bostanci O, Sahin B, et al. The average values of the nasal anthropometric measurements in 108 young Turkish males. Auris Nasus Larynx. 2006;33:31-5.
  • 30. Uzun A, Ozdemir F. Morphometric analysis of nasal shapes and angles in young adults. Braz J Otorhinolaryngol. 2014;80:397-402.
  • 31. Janis JE, Rohrich RJ. Rhinoplasty. In: Thorne C, Beasley R, Aston S, Bartlett S, Gurtner G, editors. Grabb and Smith’s Plastic Surgery. Philadelphia: Lippincott Williams and Wilkins; 2007:517-32.
  • 32. Flint PW, Haughey BH, Lund VJ, Niparko JK, Richardson MA, Robbins KT, Thomas R. Cummings Otolaryngology: Head & Neck surgery, 5th edn. St Louis (MO): Mosby Elsevier;2011; p679.
  • 33. Monjas-Cánovas I, García-Garrigós E, Arenas-Jiménez JJ, Abarca-Olivas J, Sánchez-Del Campo F, Gras-Albert JR. Radiological anatomy of the ethmoidal arteries: CT cadaver study. Acta Otorhinolaringologica (English Edition). 2011:62;367-74.
  • 34. Greco MG, Mattioli F, Alberici MP, Presutti L. Recurrent Massive Epistaxis from an Anomalous Posterior Ethmoid Artery. Case Rep Otolaryngol 2016; 2016: 8504348.

Çocukluk dönemi tekrarlayan idiopatik epistaksiste nazofrontal açının önemi

Year 2019, Volume: 5 Issue: 3, 1788 - 1795, 31.12.2019
https://doi.org/10.30569/adiyamansaglik.638799

Abstract

Amaç: Epistaksis çocukluk çağında yaygın, genellikle kendi kendini
sınırlayan klinik bir durumdur. Epistaksis etyolojisinde birçok faktör
kanıtlanmış olsa da, üçte biri idiopatik olarak değerlendirilmektedir.
Tekrarlayan idiopatik epistaksis vakalarının değerlendirilmesinde anatomik yapı
dikkate alınmalıdır. Bu çalışmanın amacı, çocuklarda nazofrontal açı (NFA) ile
tekrarlayan idiyopatik epistaksis arasında bir ilişki olup olmadığını ortaya
koymaktır.

Yöntem: Ekim 2014-Nisan 2015 tarihleri arasında tekrarlayan epistaksis nedeniyle
pediatrik ve kulak burun boğaz polikliniğine başvuran hastalar çalışmaya alındı
ve çalışma grubu olarak kabul edildi. Kontrol grubu, burun kanaması olmayan
hastalardan seçildi. NFA, aynı araştırmacı tarafından normal anatomik
pozisyonda ticari bir açı ölçer ile ölçülmüştür.

Bulgular: Tekrarlayan idiyopatik epistaksisi olan altmış iki olgu ve epistaksisi
olmayan doksan olgu çalışmaya alındı ve sırasıyla çalışma grubu ve kontrol
grubu olarak adlandırıldı. Çalışma grubunun ortalama NFA değeri 139,29 ± 6
(125-159) º iken, kontrol grubunun ortalama NFA değeri 133,8 ± 4,8 (123-146) º
idi. NFA, çalışma grubunda kontrol grubundan anlamlı olarak yüksekti (p<0.001).







Sonuç: NFA’nın artışı epistaksis etyolojisi sınıflamasında burnun anatomik yapı
bozukluklarından biri olarak kabul edilebilir. NFA'nın tekrarlayan idiyopatik
epistaksis için önemini belirlemek için daha fazla araştırmaya ihtiyaç
duyulmaktadır.

References

  • References1. Haddad Jr J. Epistaxis. In: Kleigman RM, Stanton BF, St Geme JW, Schor NF, Behrman RE, editors. Nelson Textbook of Pediatrics. Philadelphia: Elsevier Saunders Inc; 2011:1432-3.
  • 2. Bjelakovic B, Bojanovic M, Lukic S, Saranac L, Vukomanovic V, Prijic S, Zivkovic N, Randjelovic D.. The therapeutic efficacy of propranolol in children with recurrent primary epistaxis. Drug Des Devel Ther. 2013;7:127-9.
  • 3. Ahmed AE, Abo El-Magd EA, Hasan GM, El-Asheer OM. A comparative study of propranolol versus silver nitrate cautery in the treatment of recurrent primary epistaxis in children. Adolesc. Health Med Ther. 2015;6:165-70.
  • 4. Varshney S, Saxena RK. Epistaxis: A retrospective clinical study. Indian J Otolaryngol Head Neck Surg. 2005;57(2):125-9.
  • 5. Yau S. An update on epistaxis. Aust Fam Physician. 2015;44(9):653-6.
  • 6. Kodiya AM, Labaran AS, Musa E, Mohammed GM, Ahmad BM. Epistaxis in Kaduna, Nigeria: a review of 101 cases. Afr Health Sci. 2012;12(4):479-82.
  • 7.Wahab M S A, Fathy H, Ismail R, Mahmoud N. Recurrent epistaxis in children: When should we suspect coagulopathy?. The Egyptian Journal of Otolaryngology. 2014;30(2):106-11.
  • 8. Kucik CJ, Clenney T. Management of epistaxis. Am Fam Physician. 2005;71:305-11.
  • 9. Qureishi A, Burton MJ. Interventions for recurrent idiopathic epistaxis (nosebleeds) in children. Cochrane Database Syst Rev. 2012;9:CD004461.
  • 10. Oztürk H, Ipek A, Tan S, Yener Öztürk S, Keskin S, Kurt A, Arslan H. Evaluation of fetal nasofrontal angle in the second trimester in normal pregnancies. J Clin Ultrasound. 2011;39:18-20.
  • 11. Cicero S, Curcio P, Papageorghiou A, Sonek J, Nicolaides K. Absence of nasal bone in fetuses with trisomy 21 at 11-14 weeks of gestation: an observational study. Lancet. 2001;358(9294):1665-7.
  • 12. van der Heijden P, Korsten-Meijer AG, van der Laan BF, Wit HP, Goorhuis-Brouwer SM. Nasal growth and maturation age in adolescents: a systematic review. Arch Otolaryngol Head Neck Surg. 2008;134:1288-93.
  • 13. Song KJ, Lee EJ, Lee JM, Jo GH, Kim KS. The effect of caudal septoplasty on nasal angle parameters: a report on 69 cases. Clin Otolaryngol. 2016;41:185-9.
  • 14. Adams DJ, Clark DA. Common genetic and epigenetic syndromes. Pediatr Clin North Am. 2015;62:411-26.
  • 15. Bernius M, Perlin D. Pediatric ear, nose, and throat emergencies. Pediatr Clin North Am. 2006;53:195-214.
  • 16. Sandoval C, Dong S, Visintainer P, Ozkaynak MF, Jayabose S. Clinical and laboratory features of 178 children with recurrent epistaxis. J Pediatr Hematol Oncol. 2002;24:47-9.
  • 17. Zhou F, Xu Y, Zhang Z, Wu X, Jin R. Severe Hemorrhage in Chinese Children With Immune Thrombocytopenia. J Pediatr Hematol Oncol. 2015;37:e158-61.
  • 18. Kikidis D, Tsioufis K, Papanikolaou V, Zerva K, Hantzakos A. Is epistaxis associated with arterial hypertension? A systematic review of the literature. Eur Arch Otorhinolaryngol. 2014;271:237-43.
  • 19. Comelli I, Vincenti V, Benatti M, Macri GF, Comelli D, Lippi G, Cervellin G. Influence of air temperature variations on incidence of epistaxis. Am J Rhinol Allergy. 2015;29:e175-81.
  • 20. Abou-Elfadl M, Horra A, Abada RL, Mahtar M, Roubal M, Kadiri F. Nasal foreign bodies: Results of a study of 260 cases. Eur Ann Otorhinolaryngol Head Neck Dis. 2015;132:343-6.
  • 21. Murray AB, Milner RA. Allergic rhinitis and recurrent epistaxis in children. Ann Allergy Asthma Immunol. 1995;74:30-3.
  • 22. Petty DA, Blaiss MS. Intranasal corticosteroids topical characteristics: side effects, formulation, and volume. Am J Rhinol Allergy. 2013;27:510-3.
  • 23. Daniel M, Raghavan U. Relation between epistaxis, external nasal deformity, and septal deviation following nasal trauma. Emerg Med J. 2005;22:778-9.
  • 24. O'Reilly BJ, Simpson DC, Dharmeratnam R. Recurrent epistaxis and nasal septal deviation in young adults. Clin Otolaryngol Allied Sci. 1996;21:12-4.
  • 25. Liu T, Han D, Wang J, Tan J, Zang H, Wang T, Li Y, Cui S. Effects of septal deviation on the airflow characteristics: using computational fluid dynamics models. Acta Otolaryngol. 2012;132(3):290-8.
  • 26. Chen XB, Lee HP, Chong VF, Wang de Y. Assessments of nasal bone fracture effects on nasal airflow: A computational fluid dynamics study. Am J Rhinol Allergy. 2011;25:e39-43.
  • 27. Bailie N, Hanna B, Watterson J, Gallagher G. A model of airflow in the nasal cavities: Implications for nasal air conditioning and epistaxis. Am J Rhinol Allergy. 2009;23:244-9.
  • 28. Tezel E, Durmuş FN. A new instrument for achieving a natural nasofrontal angle. J Plast Reconstr Aesthet Surg. 2009;62:e617-9.
  • 29. Uzun A, Akbas H, Bilgic S, Emirzeoglu M, Bostanci O, Sahin B, et al. The average values of the nasal anthropometric measurements in 108 young Turkish males. Auris Nasus Larynx. 2006;33:31-5.
  • 30. Uzun A, Ozdemir F. Morphometric analysis of nasal shapes and angles in young adults. Braz J Otorhinolaryngol. 2014;80:397-402.
  • 31. Janis JE, Rohrich RJ. Rhinoplasty. In: Thorne C, Beasley R, Aston S, Bartlett S, Gurtner G, editors. Grabb and Smith’s Plastic Surgery. Philadelphia: Lippincott Williams and Wilkins; 2007:517-32.
  • 32. Flint PW, Haughey BH, Lund VJ, Niparko JK, Richardson MA, Robbins KT, Thomas R. Cummings Otolaryngology: Head & Neck surgery, 5th edn. St Louis (MO): Mosby Elsevier;2011; p679.
  • 33. Monjas-Cánovas I, García-Garrigós E, Arenas-Jiménez JJ, Abarca-Olivas J, Sánchez-Del Campo F, Gras-Albert JR. Radiological anatomy of the ethmoidal arteries: CT cadaver study. Acta Otorhinolaringologica (English Edition). 2011:62;367-74.
  • 34. Greco MG, Mattioli F, Alberici MP, Presutti L. Recurrent Massive Epistaxis from an Anomalous Posterior Ethmoid Artery. Case Rep Otolaryngol 2016; 2016: 8504348.
There are 34 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Research Article
Authors

İbrahim Hakan Bucak 0000-0002-3074-6327

Mehmet Karataş 0000-0001-8974-3414

Habip Almış 0000-0001-9327-4876

Sedat Doğan

Mehmet Turgut 0000-0002-2155-8113

Publication Date December 31, 2019
Submission Date October 27, 2019
Acceptance Date December 10, 2019
Published in Issue Year 2019 Volume: 5 Issue: 3

Cite

AMA Bucak İH, Karataş M, Almış H, Doğan S, Turgut M. The Importance of Nasofrontal Angle in Recurrent Childhood Idiopathic Epistaxis. ADYÜ Sağlık Bilimleri Derg. December 2019;5(3):1788-1795. doi:10.30569/adiyamansaglik.638799