Cauterization (orcauterisation, orcautery) is a medical practice or technique ofburning a part of a body to remove or close off a part of it. It destroys some tissue in an attempt to mitigatebleeding and damage, remove an undesired growth, or minimize other potential medical harm, such asinfections whenantibiotics are unavailable.[1]
The practice was once widespread for treatment of wounds. Its utility before the advent of antibiotics was said to be effective at more than one level:
Cautery was historically believed to prevent infection, but current research shows that cautery actually increases the risk for infection by causing more tissue damage and providing a more hospitable environment for bacterial growth.[2]Actual cautery refers to the metal device, generally heated to a dull red glow, that a physician applies to produceblisters, to stopbleeding of ablood vessel, and for other similar purposes.[3]
The main forms of cauterization used today areelectrocautery andchemical cautery—both are, for example, prevalent in cosmetic removal ofwarts and stoppingnosebleeds. Cautery can also mean thebranding of a human.
Cauterize is aMiddle English word borrowed from the Old Frenchcauteriser, from Late Latincauterizare "to burn or brand with a hot iron", from Ancient Greekκαυτηριάζειν (kauteriazein), fromκαυτήρ (kauter), "burning or branding iron", andκαίειν (kaiein) "to burn" (of caustic).[4]
Cauterization has been used to stop heavy bleeding since antiquity. The process was described in theEdwin Smith Papyrus[5] andHippocratic Corpus.[6] It was primarily used to control hemorrhages, especially those resulting from surgery, inancient Greece.Archigenes recommended cauterization in the event of hemorrhaging wounds, andLeonides of Alexandria described excising breast tumors and cauterizing the resulting wound in order to control bleeding.[7] The ChineseSu wen recommends cauterization as a treatment for various ailments, including dog bites.[8]Indigenous peoples of the Americas,ancient Arabs, and Persians also used the technique.[9]
Tools used in the ancient cauterization process ranged from heated lances to cauterizing knives. The piece of metal was heated over fire and applied to the wound.[10]
Cauterization continued to be used as a common treatment in medieval times. TheBabylonian Talmud (redacted in 500 AD), alluding to the practice, states: "... and the effect of the hot iron comes and removes the traces of the stroke."[11] While mainly employed to stop blood loss, it was also used in cases of tooth extraction and as a treatment for mental illness. In theMuslim world, scholarsAl-Zahrawi andAvicenna wrote about techniques and instruments used for cauterization.[12]
As late as the 20th-century,Bedouins of theNegev in Palestine had it as their practice to take the root of the shaggy sparrow-wort (Thymelaea hirsuta), cut the root into splinters lengthwise, burn the splinter in fire, and then apply the red-hot tip of a splinter to the forehead of a person who was ill with ringworm (dermatophytosis).[13]
The technique ofligature of the arteries as an alternative to cauterization was later improved and used more effectively byAmbroise Paré.
Electrocauterization is the process of destroying tissue (or cutting through soft tissue) usingheat conduction from a metal probe heated by electric current. The procedure stops bleeding from small vessels (larger vessels beingligated). Electrocautery applies high frequency alternating current by aunipolar orbipolar method. It can be a continuouswaveform to cut tissue, or intermittent to coagulate tissue.
The electrically produced heat in this process inherently can do numerous things to the tissue, depending on the waveform and power level, including cauterize, coagulate, cut, and dry (desiccate). Thus electrocautery, electrocoagulation, electrodesiccation, and electrocurettage are closely related and can co-occur in the same procedure when desired.Electrodesiccation and curettage is a common procedure.
In unipolar cauterization, the physician contacts the tissue with a single small electrode. The circuit's exit point is a large surface area, such as the buttocks, to prevent electrical burns. The amount of heat generated depends on the size of contact area, power setting or frequency of current, duration of application, and waveform. A constant waveform generates more heat than intermittent. The frequency used in cutting the tissue is higher than in coagulation mode.
Bipolar electrocautery passes the current between two tips of a forceps-like tool. It has the advantage of not disturbing other electrical body rhythms (such as the heart) and also coagulates tissue by pressure. Lateral thermal injury is greater in unipolar than bipolar devices.[14]
Electrocauterization is preferable to chemical cauterization, because chemicals can leach into neighbouring tissue and cauterize outside of intended boundaries.[15] Concern has also been raised regarding toxicity of thesurgical smoke electrocautery produces. This contains chemicals that, through inhalation, may harm patients or medical staff.[16]
Ultrasonic coagulation and ablation systems are also available.
Many chemical reactions can destroy tissue, and some are used routinely in medicine, most commonly to remove small skin lesions such aswarts or necrotized tissue, or forhemostasis.[17] Because chemicals can leach into areas not intended for cauterization, laser and electrical methods are preferable where practical.[18] Some cauterizing agents are:
Frequentnosebleeds are most likely caused by an exposed blood vessel in the nose, usually one inKiesselbach's plexus.
Even if the nose is not bleeding at the time, a physician may cauterize it to prevent future bleeding. Cauterization methods include burning the affected area with acid, hot metal, or lasers. Such a procedure is naturally quite painful. Sometimes, a physician usesliquid nitrogen as a less painful alternative, though it is less effective. A physician may applycocaine in the few countries that allow it for medical use. Cocaine is the onlylocal anesthetic that also producesvasoconstriction,[23] making it ideal for controlling nosebleeds.
More modern treatment appliessilver nitrate after a local anesthetic. The procedure is generally painless, but after the anesthetic wears off, there may be pain for several days, and the nose may run for up to a week after this treatment.
Nasal cauterization can causeempty nose syndrome.[24][25][26]
Cauterization has been used for thecircumcision of infants in theUnited States andCanada. TheCollege of Physicians and Surgeons of Manitoba advises against its use in neonatal circumcision.[27] This method of circumcision resulted in several infants having theirpenises severely burned.[28][29][30][31][32][33]
Although total turbinate excision is most frequently the cause of ENS, lesser procedures (eg, submucosal cautery, submucosal resection, cryosurgery) to reduce the turbinates may cause problems as well if performed in an overly aggressive manner.
à la suite d'interventions endonasales diverses (turbinectomie, turbinoplastie, cautérisation...
ENS is a complication of middle and/or inferior turbinate surgery, most frequently total turbinate excision, but also with minor procedures such as submucosal cautery, submucosal resection, laser therapy, and cryosurgery if performed in an aggressive manner
