Endoscopic endonasal greater palatine artery cauterization at the incisive foramen for control of anterior epistaxis

Abstract

4. Laryngoscope, 126:1033-1038, 2016.

The Incisive Canal: A Comprehensive Review

“…Nosebleeds occur frequently and have a 60% prevalence in the general population [ 30 ]. Eighty percent of nosebleeds are anterior and involve the Little’s area—the anastomosis between the posterior septal branch of the sphenopalatine artery, the nasal septal branch of the superior labial artery, and the branches of the anterior ethmoidal artery.…”

“…Bleeding is usually managed conservatively; however, intractable bleeding warrants surgical intervention by cauterization, ligation, or embolization. Surgical interventions usually address posterior septal branches of the sphenopalatine artery or the maxillary artery (IMAX ligation: Caldwell–Luc approach) [ 30 ].…”

“…Butrymowicz et al described a unique approach to epistaxis: endoscopically cauterizing the sphenopalatine artery via an endonasal approach at the incisive foramen [ 30 ]. Complications include septal perforation, septal hematomas, and dental and palatal anesthesia.…”

“…One of the patients in their study suffered a small septal perforation that was attributed to the preexisting friable mucosa. All patients in this study also remained free of nose bleeds for 24 months after the procedure [ 30 ]. The procedure was performed under general anesthesia, and the nasal septum was infiltrated with 5 mL of 1% lidocaine.…”

“…The septal flap was then laid back in place and sutured using interrupted 4.0 chromic sutures. The nasal splints were trimmed and fitted for the anterior septum and then sutured in place using a mattress 2.0 prolene suture [ 30 ]. The authors also suggested that the anterior nasal spine be used as a reliable landmark for the depth of the incisive canal, as it was consistently located within 1 cm from the anterior nasal spine on cadaveric specimens and radiographs [ 30 ].…”