Endoscopic intranasal control of hemorrhage from unexpected ethmoidal hemangioma during conchoplasty: A case report

INTRODUCTION AND IMPORTANCE: Hemangiomas of paranasal sinuses are rare. Unexpected hemangiomas of this region can bleed profusely leading to operative morbidity and mortality. Hemangiomas of paranasal sinuses may be associated with concha bullosa. CASE PRESENTATION: We report a case of 41-year-old female who presented with difficulty in nose breathing and headache since two years. She was diagnosed with concha bullosa with deviated nasal septum and was planned for endoscopic septoplasty and conchoplasty. During the procedure, profuse, unexpected hemorrhage resulted from the undiagnosed hemangioma which was managed by endoscopic intranasal cauterization of anterior ethmoidal artery. DISCUSSION: Hemangiomas of paranasal sinuses such as ethmoidal sinus are rare. These are slow growing tumors and may be radiologically silent. Due to high vascularity of these lesions, it may be very difficult to manage associated bleeding. A sound knowledge of vascular anatomy of this area is important in managing intraoperative complications. Until now, only a few cases of ethmoidal hemangiomas have been reported in association with concha bullosa. Screening for these lesions may be important in patients with concha bullosa. CONCLUSION: Sound knowledge of surgical anatomy forms the basis of managing intraoperative complications in endoscopic sinus surgery. Further research should be carried out to find out the association between concha bullosa and ethmoidal hemangioma and patients with concha bullosa should be screened with advanced imaging techniques for such vascular lesions where feasible.