DR VIKRAM BHARDWAJ
Canalis Sinuosus (CS) is a bony canal for Anterior Superior Alveolar (ASA) nerve and corresponding vessels. Variants of this canal are infrequently reported and can have significant clinical implications.
We encountered one such case which presented with oral bleed and was managed successfully. Case Report A 38 year old lady presented with continuous fresh bleed from oral cavity for last 2 months. Bleeding was spontaneous in onset with no history of iatrogenic or accidental trauma.
No history of any comorbidities with normal general physical examination. On clinical head and neck examination, there was a well demarcated bleeding site from left side hard palate in paramedian location which was relieved by local pressure. The mucosa around the bleeding point was unremarkable. There were no associated comorbidities or bleeding diatheses.
Routine blood tests and coagulation profile was normal. She had been given a palatal obturator for pressure tamponade by the local dentist for temporary control of bleeding (Video 1).
A Conal Beam CT Scan (CBCT) (Figure 1) was done which revealed a rare canalis sinuosus variant which was the origin of bleeding. CBCT was reported as a well defined radioluscent canal with respect to palatal aspect of tooth #22 continuous with lateral aspect of nasal cavity. Canal is opening at a distance of 7.9 mm from tooth #22 . Treatment options were considered to stop the continuous flow of blood. We discussed the case with our interventional radiology colleagues to ascertain the possibility of occluding the vessel and the canal using Digital Subtraction Angiography (DSA) (Figure 4).
Patient was counselled and planned as a day care procedure. The vessel/canal was occluded using histoacryl glue (33% lipoidal mixture) and bleeding stopped on table. Till the time of this case report, it has been 2 months and there has been no recurrence of bleeding from the site.
THE CASE REPORT IS PUBLISHED IN JOURNAL OF OTOLARYNGOLOGY