Nasal septal perforation: A possible local complication of topical adrenaline 1:1,000

Lilleen Huang, Jin Keat Siow


Background: Topical adrenaline 1:1,000 is one of a variety of vasoconstrictors used in endoscopic sinus surgery. It is increasingly being used as a topical agent of choice for its very reliable efficacy. Studies have shown that systemic cardiopulmonary complications have been uncommon. There have been no reports of untoward local effects on nasal mucosa.
Methods: Two patients who underwent endoscopic sinus surgery developed post-operative nasal septal perforation following the use of topical adrenaline 1:1,000 soaked in surgical patties which were applied on both sides of the nasal septum for a period of approximately 20 minutes.
Results: Exposure of previously healthy nasal septal mucosa to topical adrenaline of high concentration 1:1,000 resulted in the post-operative development of slough and subsequent nasal septal perforation.
Conclusions: Topical adrenaline 1:1,000 should be used with great caution as a vasoconstrictor during endoscopic sinus surgery. Prolonged (20 minutes) and simultaneous contact with the nasal septal area should be avoided to prevent post-operative nasal septal perforation.

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Higgins TS, Hwang PH, Kingdom TT, Orlandi RR, Stammberger H, Han JK. Systematic Review of Topical Vasoconstrictors in Endoscopic Sinus Surgery. Laryngoscope 2011 Feb; 121(2):422-32.



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Case Studies in Surgery  ISSN 2377-7311(Print)  ISSN 2377-732X(Online)

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