Cauterization involves burning a fabric, either by means of a conductor carried hot by an electric current or by means of a chemical. The goal is then either to destroy a diseased tissue or to stop bleeding. Etymologically, the term comes from the Latin name cautionary, which means cauterization, and was formed from the Latin verb I will cauterize meaning “to burn with a hot iron”.

Concretely, this destruction of a tissue makes it possible to remove a lesion but also to stop a bleeding or to regress the exuberant budding of a scar. Cauterization is most often performed on the skin or on a mucous membrane. Old electrical devices such as the galvanocautery or the thermocautery, a rod kept incandescent to allow for intense heat, are no longer used today.

Historically, cauterization has been used since the Middle Ages. Thus, Albucassis (936-1013), an Arab surgeon from Spain who was also the great master of Spanish-Arab surgery at the time, produced many innovations in medicine. Among them: hemostasis by digital compression and white iron cauterization. Subsequently, in the XVI^e century, the surgeon Ambroise Paré (1509-1590) distinguished himself on the battlefields, bringing many innovations in the treatment of wounds. He thus invented the ligation of arteries to replace cauterization with red iron. In fact, he, who was the inventor of many instruments and is often considered the father of modern surgery, was involved in the improvement and dissemination of a new type of cauterization technique, at a time when cauterized with red iron or boiling oil, at the risk of killing the wounded.

Cauterization is used mainly in the case where it is necessary to stop a hemorrhage, and in particular the epistaxis (a nosebleed), or to treat cancers. It is also indicated, in some cases, to promote better breathing through the nose.

• Nose bleeds: lNasal bleeding, also called epistaxis, can be moderate or heavy, and its consequences can range from a minor disorder to potentially life-threatening bleeding. It is particularly in cases of severe or repeated bleeding that doctors may sometimes have recourse to cauterization. Thus, caregivers then plug the source of the bleeding using a chemical agent, very often silver nitrate, or perform cauterization using a heating electric current. This second technique is also called electrocautery, and means that the cauterization of the tissues is carried out by means of a conductor heated by an electric current;
• Cancer treatment: electrocautery, using a high frequency electric current to destroy cells or tissues, can be used in cancer, to stop bleeding from the tumor blood vessels, or to remove parts of the cancerous tumor. For example, electrocautery is used in lung cancer because it removes parts of this tumor located near a blood vessel;
• Breathe better through the nose: cauterization of the turbinates aims to improve breathing through the nose. Thus, the nose contains turbinates, which are bones covered with soft tissue. When the mucous membranes of the turbinates are too swollen by the blood passing inside, these mucous membranes do not allow air to pass well: they therefore prevent the patient from breathing well through the nose. The intervention, which will also be a cauterization here, will make these mucous membranes thinner, generating better breathing.

Cauterization performed to treat epistaxis is a relatively benign gesture, it is not really an operation. This cauterization is performed under local contact anesthesia. This requires a cotton swab, which is soaked in anesthetic fluid before being held for a few minutes in the nostril and then removed.

The instrument that performs the cauterization itself is then applied for a few seconds to the area to be coagulated. This cauterization can be performed with a chemical, such as silver nitrate or chromic acid: this technique, which generally involves the use of a silver nitrate stick, allows a blood vessel visible inside the nose and which is prone to rupture. This cauterization can also be performed using electric tweezers: this is then an electrocoagulation.

All ENT (otorhinolaryngology) specialists are likely to perform this type of cauterization. This can be done either in their consulting room or in an ENT department in a hospital setting. The gesture can be applied to children, especially if they are calm: nasal cauterization with silver nitrate under local anesthesia is thus possible from the age of four to five years. This method of closure represented by cauterization can sometimes be painful, despite local anesthesia.

The other types of cauterization involve cancers, and in this case the intervention will aim to destroy the abnormal tissue or cancer cells by means of a source of heat, an electric current or a chemical product. In addition, cauterization of the turbinates, small bones located inside the nose, is also practiced: here, the goal will be to allow the patient to breathe better.

To prepare for a cauterization procedure, if you usually take it, you will have to make sure, in particular, to stop a few days before the operation from taking medications that aim to make the blood more fluid, such as for example:

• anti-coagulants;
• anti-inflammatory drugs;
• anti-platelet drugs.

It will also be better for smokers to stop smoking before and after surgery, as this increases the risk of infection after surgery, and most importantly, it delays healing, especially in the case of cauterization of cornets.

Cauterization to treat epistaxis usually gives satisfactory results. This will remove some of the blood vessels that cause the bleeding.

Cauterization for the treatment of cancer results in the destruction of cancer cells, or abnormal tissue.

As for the cauterization of the turbinates, which consists in using heat in order to “burn” the blood vessels which pass through the mucous membranes, it results in less blood swelling of the mucous membranes. Reducing the size of these mucous membranes, the operation will therefore make it possible to free up space for the passage of air. The patient’s breathing will indeed be improved.

There are risks in terms of cauterization in the treatment of epistaxis when these procedures are repeated frequently: in the long term, perforation of the nasal septum may occur. However, this inconvenience does not cause any particular complication, it can simply be the cause of a little bloody nasal crusts.

Concerning the cauterization of the turbinates, the risks are low, however, it can, quite rarely, occur an infection at the site of the intervention, it can also in rare cases trigger bleeding or an accumulation of blood under the mucous membrane, which will cause a hematoma.

Finally, it has been shown in scientific studies that the electro-coagulation method causes more inflammation and necrosis than scalpel surgery, for example in the case of laparotomy. And in fact, cauterization actually seems to increase the risk of infection compared to other surgical methods.

The hypothesis put forward by a group of researchers (Peter Soballe and his team) is that a lower number of bacteria is required to infect wounds caused by electro-cautery than to infect wounds caused by a scalpel.