Article

Endoscopic control of the sphenopalatine artery for epistaxis: long-term results.

Department of Otolaryngology, University of Dundee, Ninewells Hospital and Medical School, Dundee, Scotland, UK.
The Journal of Laryngology & Otology (impact factor: 0.6). 09/2007; 121(8):759-62. DOI:10.1017/S0022215106003379
Source: PubMed

ABSTRACT The aim of this study was to prospectively evaluate post-operative cessation of bleeding and late recurrence of epistaxis in a cohort of patients treated by endoscopic ligation of the sphenopalatine artery. Participants comprised patients undergoing sphenopalatine artery ligation for posterior epistaxis at three east Scotland hospitals. Main outcome measures were recurrence of epistaxis in the immediate post-operative period and at long-term follow up (minimum nine months). Forty-three patients (30 men and 13 women) underwent 45 procedures; two patients underwent bilateral ligation. Two patients suffered recurrence as in-patients. Two patients experienced subsequent epistaxis requiring medical treatment. Two further patients suffered minor late epistaxis not requiring treatment. Success in preventing significant recurrence was 93 per cent. All recurrences requiring intervention occurred within one month of surgery. None of the patients in this series reported nasal complications. We found sphenopalatine artery ligation to be an effective means of achieving long-term control of posterior epistaxis.

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    Article: Sphenopalatine artery ligation under local anesthesia: A report of two cases and review of the literature.
    Nico Jonas, Laura Viani, M Walsh
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    ABSTRACT: Epistaxis is the commonest emergency in otorhinolaryngology. Over the last decade endoscopic sphenopalatine artery (SPA) ligation has become a popular treatment option for posterior epistaxis and has been shown to be the most effective and cost-efficient definitive treatment for posterior epistaxis. SPA ligation is usually performed under general anesthesia. The majority of epistaxis patients are elderly, frail and have multiple medical conditions. These patients are therefore not always amenable to general anesthesia. In this article we describe two cases where posterior epistaxis was successfully treated with sphenopalatine artery ligation under local anesthesia and should be considered suitable for patients with severe posterior epistaxis who are not fit for a general anesthetic.
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    Tor Chiu
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    ABSTRACT: Arterial ligation remains a key option in the treatment of persistent epistaxis and clarification of the arterial configuration of the distal maxillary/sphenopalatine artery is important for understanding the rationale behind current surgical treatments. Greater understanding of the arterial anatomy will reduce the risk of technical failures and improve the reliability of surgical interventions for persistent epistaxis and will also be useful for surgeries involving the pterygopalatine fossa. Anatomical study in cadavers. This is an anatomical study of 128 cadaveric tissue blocks containing the pterygopalatine fossa. In total, 118 tissue blocks were microdissected using a Watson-Barnet dissecting microscope. Ten injected tissue blocks were cleared by the Spalteholz technique. Photographic records were made. Analysis demonstrated three common configurations of the maxillary artery in the pterygopalatine fossa: a single looped form (18%) and two double-looped forms, 'E' (51%) and 'M' (31%). The maxillary artery bifurcates before the sphenopalatine foramen in 105 cases (89%). The sphenopalatine foramen lies at the posterior end of the middle turbinate; in 58% of cases it lies in both the superior and middle meati. Asymmetry in the size of the maxillary arteries was uncommon; only 3% could be described as 'dominant'. The arterial configuration of the maxillary artery in the pterygopalatine fossa can be complex but may be classified into one of three forms. Some configurations may be more liable to lead to difficulties with branch identification during surgical treatment of epistaxis particularly in combination with an inadequate osteotomy. Clinicians should expect to find more than one vessel exiting the sphenopalatine foramen and actively search for these during surgery. Asymmetry in the maxillary/sphenopalatine arteries is not common and contralateral ligations are not indicated.
    Rhinology 09/2009; 47(3):264-70. · 1.32 Impact Factor
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Keywords

45 procedures
 
bilateral ligation
 
east Scotland hospitals
 
endoscopic ligation
 
immediate post-operative period
 
in-patients
 
long-term control
 
medical treatment
 
minor
 
nasal complications
 
patients
 
patients undergoing sphenopalatine artery ligation
 
post-operative cessation
 
recurrences
 
sphenopalatine artery
 
sphenopalatine artery ligation