Management of Plicoma with Sporadic Live Bleeding
Initial Acute Bleeding Management
- Apply firm, sustained compression to the lower third of the nose for ≥ 5 minutes as first‑line therapy for epistaxis in patients with plicoma 1.
- Use topical vasoconstrictors (oxymetazoline or phenylephrine) as spray or cotton applicator, achieving hemostasis in 65–75 % of cases 1.
- After bleeding stops, humidify the nasal mucosa with saline solution and emollient agents to promote mucosal healing 1.
- If bleeding persists, perform localized chemical or electrical cauterization under local anesthesia, limited to the active bleeding site 1.
Guideline source: American Academy of Otolaryngology‑Head and Neck Surgery (AAO‑HNS).
Pre‑operative Evaluation
- Obtain computed tomography (CT) and/or magnetic resonance imaging (MRI) before surgery to delineate lesion extent and facilitate surgical planning 4.
Guideline source: AAO‑HNS.
Definitive Surgical Management
- Perform complete surgical excision of the plicoma, including removal of involved mucosa and the underlying perichondrium, to prevent recurrence because the lesion does not involute spontaneously 4.
Guideline source: AAO‑HNS.
Post‑operative Care
- Advise patients to avoid nose blowing, strenuous activity, lifting > 10 lb, and bending over during the immediate recovery period 5.
- Recommend head elevation while sleeping to reduce postoperative edema 5.
- Prescribe saline nasal spray and humidifying agents 1–3 times daily to maintain mucosal moisture 7.
- Provide analgesia with acetaminophen and avoid aspirin or ibuprofen to minimize bleeding risk 5.
- Schedule a follow‑up visit at 30 days to document clinical evolution 7.
Guideline source: AAO‑HNS.
Warning Signs Requiring Urgent Re‑evaluation
- Return of nasal or oral bleeding 5
- Fever > 38.3 °C (101 °F) 9
- Progressive facial or nasal pain 4
- New visual disturbances 4
- Dyspnea or respiratory difficulty 7
- Loss of coloration of the nasal skin 5
- Facial edema or diffuse cutaneous rash 6
Guideline source: AAO‑HNS.