Treatment of pediatric epistaxis based on the vascular pathology was observed using an electronic endoscope —thumb press maneuver (TPM)—

Abstract

 The vascular pathology was observed using an electronic endoscope with normal light and narrow band imaging (NBI) in 77 patients with pediatric epistaxis aged 15 years or younger who visited the outpatient clinic of our department over the past 6 years, and the characteristics of the frequent development sites and 6 types of vascular morphology classification were clarified. The development site was located near the mucocutaneous junction of the anteroinferior nasal septum and near Kiesselbach's area in more than 95%. The vascular morphology was the linear type in 39 patients (50.6%), reticular type in 34 (44.2%), granular type in 2 (2.6%), punctate type in 1 (1.3%), and aneurysmal type in 1 (1.3%). The recessed type was not observed in any patient, and all cases were venous hemorrhage. Based on the frequent development site of pediatric epistaxis and its vascular pathology, the thumb press maneuver (TPM): pressing the nasal ala to the median nasal septum with the thumb on the affected side while opening the palm and setting the other fingers at the contralateral mandibular angle and pinching the held region, is rational and effective to achieve hemostasis for the initial treatment of pediatric epistaxis.