Endoscopic view of a nasal septal hemangioma causing obstruction.

A 32-year-old man was evaluated for a complete right nasal obstruction and intermittent nasal bleeding of several months' duration. Clinical examination revealed the presence of a large exophytic polypoid lesion with a friable mucosal surface that filled the right nasal airway (figure, A). Assessment of the posterior extent of this mass was difficult. Computed tomography (CT) of the nose and sinuses detected a roundish soft-tissue mass in the anterior portion of the right nasal airway; the mass appeared to originate in the anterior septum (figure, B). Findings in the paranasal sinuses were negative.

[FIGURE A-B OMITTED]

The patient underwent excision of the right intranasal lesion under general anesthesia. Careful examination with a suction revealed that the lesion had originated in the anterior portion of the nasal septum on the right side (Kiesselbach's area) (figure, C). It was removed with electrocautery, and complete hemostasis was achieved. The procedure provided for an excellent airway on the right side (figure, D). The pathologic diagnosis was a focally ulcerated capillary hemangioma. The patient's postoperative course was uneventful.

[FIGURE C-D OMITTED]

The capillary hemangioma is a common vascular tumor of the anterior nasal septum. (1) It may appear as a pedunculated friable polypoid mass on the anterior portion of the nasal septum. Its presence can cause airway obstruction and recurrent unilateral epistaxis. In this case, the lesion obstructed the nasal airway completely. CT of the sinuses helps evaluate the size and origin of the tumor and its relationship to sinus pathology, thus assisting in surgical planning. The differential diagnosis includes hamartomas, pyogenic granuloma, arteriovenous malformation, (2) and nasal polyps.

At surgery, suction helps identify the tumor's site of origin. (3) Treatment entails complete surgical or electro-cautery excision under local or general anesthesia. When available, laser excision may be an alternative.

References

(1.) Bingham BJ, Hawke M, Kwok P. Atlas of Clinical Otolaryngology. St. Louis: Mosby, 1992.

(2.) Knudsen SJ, Bailey BJ. Midline nasal masses. In: Bailey BJ, ed. Head Neck Surgery-Otolaryngology. Philadelphia: Lippincott, 1993.

(3.) Yanagisawa E, Ho SY. Suction examination of the nasal cavity--A useful technique to detect hidden polyps. Ear Nose Throat J 1998;77:806-7.

From the Southern New England Ear, Nose, Throat, and Facial Plastic Surgery Group, New Haven, Conn.; the Section of Otolaryngology, Hospital of St. Raphael, New Haven; and the Section of Otolaryngology, Yale University School of Medicine, New Haven (Dr. Yanagisawa), and the Department of Otolaryngology, University of South Florida College of Medicine, Tampa, and the Halifax Medical Center, Daytona Beach, Fla. (Dr. Mirante and Dr. Christmas).