(1068) Use of Septoplasty for Treatment of Refractory Epistaxis in Children With and Without Bleeding Disorders

Introduction: Epistaxis is a common diagnosis among pediatric patients. While most patients can be managed conservatively with simple, non-invasive measures, some require surgery to control persistent bleeding. The use of septoplasty for refractory epistaxis has not yet been well studied. We aim to compare outcomes of septoplasty for refractory epistaxis in children with and without bleeding disorders at our institution.

Methods: A retrospective review was performed of 19 pediatric patients who underwent septoplasty for recurrent epistaxis from 2014-2024. We compared demographics, number of visits prior to surgery, pre-operative treatment (ointments, nasal saline, chemical decongestants, chemical cauterizations), and post-surgery epistaxis episodes among patients with and without bleeding disorders. Bleeding disorders included Von Willebrand disease, thalassemia, platelet dysfunction, and dysfibrinogenemia.

Results: Of the 19 patients, 5 had bleeding disorders and 14 did not. All patients with bleeding disorders were male (average age 11.5 years), while 50% of non-bleeding disorder patients were male (average age 16.1 years). Patients with bleeding disorders had a higher average number of pre-surgery epistaxis visits (4.2) compared to the non-bleeding group (2.9). Those with bleeding disorders had a higher number of pre-surgical conservative management attempts using bacitracin ointment, saline spray/gel, and oxymetazoline application and underwent more chemical cauterizations. Patients with bleeding disorders had an average of 2.2 subsequent bleeding episodes compared to 0.8 among non-bleeding disorder patients.

Conclusions: Septoplasty is an effective treatment for refractory epistaxis for pediatric patients with and without bleeding disorders. Patients with bleeding disorders bled more frequently both pre- and post-surgery than those without.