Jehovah’s Witnesses patients in otorhinolaryngological surgery: A case regarding a sinonasal tumor resection

Abstract

Head and neck surgeries have a high risk of bleeding, and therefore could require the use of blood transfusions. There are cases for which blood transfusions are not an acceptable option, as is the case for Jehovah’s Witnesses. We present the case of a Jehovah’s Witness with a sinonasal tumor with a high risk of bleeding, who presented with recurrent epistaxis. Rhinoscopy and computed tomography revealed a vascular-like tumor occluding the right nasal cavity. Cerebral angiography showed afferents of the sphenopalatine and ethmoidal arteries leading to the tumor. Prior to the resection, the maxillary artery was embolized. During surgery, we relied on an autologous blood reco­very system, hemodilution and tranexamic acid. Right anterior ethmoidal artery ligation was performed by an endoscopic assisted external approach. The tumor was resected endoscopically. The biopsy revealed a squamous sinonasal carcinoma. There are thera­peutic alternatives for patients who cannot receive blood products. There are preopera­tive measures such as endovascular embolization, intraoperative measures such as the use of hemostatic agents and specific surgical or anesthetic techniques. It’s important to analyze all of the available options in a multidisciplinary team approach, and to take into consideration the patient’s preferences, in order to determine the best surgical conduct.