A case of delayed
epistaxis from the mucosa behind the right side of the inferior nasal mucosa 11 days after
orthognathic surgery by Le Fort I
osteotomy is presented. The patient was a 31-year-old man who underwent
orthognathic surgery under
general anesthesia. No abnormal findings were found during or after the operation. The patient was discharged from the hospital 10 days postoperatively. However,
bleeding from the right nasal cavity occurred suddenly on the night after discharge, and he presented to our hospital again. The
epistaxis was stopped once by nasal packing containing 0.001%
epinephrine and systemic infusion of
carbazochrome sulfonic acid and
tranexamic acid. However, when the nasal packing was removed the next day, right nasal
epistaxis was observed again. Curvature of the nasal septum and thickening of the inferior turbinate mucosa were seen on inspection; although, no active
bleeding point was identified. Decreased nasal mucosa thickening and
bleeding were observed after nasal packing containing 0.02%
epinephrine. When the inside of the nasal cavity was observed endoscopically, an approximately 2 mm
laceration was found in the mucosa behind the side wall of the right inferior nasal mucosa, and
bleeding from the same part was confirmed. After endoscopic
cauterization for hemostasis of the nasal mucosa, no rebleeding was observed. Although delayed
epistaxis after Le Fort I
osteotomy are often performed CT angiography to confirm the
bleeding site, endoscopic
cauterization would be primarily useful because of less invasiveness.