Endoscopic Ligation of the Sphenopalatine Artery and the Maxillary Artery for the Treatment of Intractable Posterior Epistaxis

Seno, Satoshi; Arikata, Masahiko; Sakurai, Hiroyuki; Owaki, Shigehiro; Fukui, Jun; Suzuki, Mikio; Shimizu, Takeshi

doi:10.2500/ajra.2009.23.3294

Cited by 33 publications

(35 citation statements)

References 11 publications

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“…However, rare but devastating risks accompany embolization procedures, including stroke, facial pain and paresthesias, ophthalmoplegia, blindness, and soft-tissue necrosis, all while carrying a higher recurrence rate for epistaxis (∼20%) than TESPAL procedures. 6,7 …”

Section: Discussionmentioning

confidence: 99%

Landmarks for Rapid Localization of the Sphenopalatine Foramen: A Radiographic Morphometric Analysis

Maxwell

Barham

Getz

et al. 2017

Allergy�Rhinol (Providence)

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Background:Transnasal endoscopic sphenopalatine artery ligation is becoming the procedure of choice for surgical management of intractable posterior epistaxis. Landmarks for localization of the sphenopalatine foramen can assist in rapid surgical exposure of the sphenopalatine artery.Objective:This study examined distances from easily identified endoscopic surgical landmarks to the sphenopalatine foramen.Methods:By using computed tomography of the sinus to study radiologic anatomy in 50 adults, distances were measured between five simple endoscopic landmarks and the sphenopalatine foramen. The two-tailed t-test was used for statistical analysis.Results:Right- and left-sided measurements were similar. The mean (standard deviation [SD]) anteroposterior distances to the sphenopalatine foramen were the following: from the maxillary line (36.7 ± 5.5 mm), anterior head of the middle turbinate (33.8 ± 6.7 mm), basal lamella (11.8 ± 1.9 mm), and choanal arch (−9.2 ± 1.4 mm). The mean (SD) distance in the vertical dimension from the nasal floor was 26.6 ± 2.6 mm. Female patients had statistically shorter distances to the sphenopalatine foramen from the maxillary line, anterior head of the middle turbinate, choanal arch, and nasal floor.Conclusion:Reliable endoscopic landmarks exist in relation to consistent anatomic structures and can be used to help quickly estimate the location of the sphenopalatine foramen at the onset of the procedure.

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Section: Discussionmentioning

confidence: 99%

Landmarks for Rapid Localization of the Sphenopalatine Foramen: A Radiographic Morphometric Analysis

Maxwell

Barham

Getz

et al. 2017

Allergy�Rhinol (Providence)

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“…Thus, more invasive procedures, such as surgery or embolization, are essential in such cases. Surgical procedures include ligation and cauterization of the sphenopalatine, internal maxillary, external carotid, and/or anterior ethmoid arteries . Previously, external carotid or internal maxillary artery surgeries were performed in cases of refractory epistaxis.…”

Section: Introductionmentioning

confidence: 99%

Sphenopalatine artery surgery for refractory idiopathic epistaxis: Systematic review and meta‐analysis

et al. 2019

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Objectives Epistaxis, especially posterior epistaxis, is occasionally refractory to treatment. In these cases, sphenopalatine artery surgeries, including cauterization and ligation, are required. Previous reports have demonstrated treatment results for these procedures but failed to provide high‐level evidence. The aim of this study was to quantify the rates of failure and perioperative complications of these procedures by using a meta‐analysis technique. Methods We systematically searched electronic databases and identified articles regarding epistaxis, sphenopalatine artery ligation, or cauterization. Pooled rebleeding and complication rates were calculated by using a random effects model. Results A total of 896 cases of sphenopalatine ligation or cauterization for epistaxis were analyzed. Pooled rebleeding rates for the entire cohort, cauterization group, and ligation group were 13.4% (95% confidence interval [CI] 10.0–17.8, P < 0.001), 7.2% (95% CI 4.6–11.0, P < 0.001), and 15.1% (95% CI 9.8–22.5, P < 0.001), respectively. Pooled perioperative complication rates for the entire cohort, cauterization group, and ligation group were 8.7% (95% CI 4.9–15.1, P < 0.001), 10.2% (95% CI 3.8–24.5, P < 0.001), and 6.4% (95% CI 1.8–20.9, P < 0.001), respectively. Conclusion Overall, sphenopalatine surgery for refractory epistaxis is an effective method because of its low rates of failure and complications. Cauterization is more effective than ligation, whereas complications are comparable between the two procedures.Laryngoscope, 129:1731–1736, 2019

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“…In contrast, endoscopic treatment of the sphenopalatine artery is an alternative that requires a shorter hospitalization period in a non‐ICU bed, and overall it has a lower case cost compared to posterior packing . It is very successful, with a failure rate of 10% to 15% . However, only 50% of otolaryngology residents in their final year of training are comfortable performing this procedure .…”

Section: Introductionmentioning

confidence: 99%

Prospective clinical trial of gelatin‐thrombin matrix as first line treatment of posterior epistaxis

et al. 2013

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Objectives/Hypothesis: To evaluate the effectiveness of gelatin-thrombin matrix for first line treatment of posterior epistaxis. Secondarily, we evaluated discomfort during treatment and the cost savings of treatment with gelatin-thrombin matrix compared to posterior packing, endoscopic, or endovascular treatment at our institution.Study Design: Prospective pilot, nonblinded, noncontrolled registered clinical trial (NCT01098578).Methods: Twenty patients with posterior epistaxis were enrolled into this study. Gelatin-thrombin matrix was used for posterior epistaxis treatment with simultaneous ipsilateral choanal occlusion. Patients were discharged within 2 hours of being successfully treated. A visual analog scale (range 0-10) was used to assess treatment discomfort. Patients were evaluated in clinic 5 and 30 days after treatment to assess for intranasal complications and recurrent epistaxis.Results: Gelatin-thrombin matrix successfully treated epistaxis in 80% of the patients. The procedure was associated with a mean discomfort of 3.6 (range 0-9.7). The institutional per case cost of treatment of patients with posterior epistaxis with gelatin-thrombin matrix is 80.3%, 87.4%, and 89.4% less than with endoscopic surgery, posterior packing, or embolization, respectively. There were no complications.Conclusion: This pilot study demonstrated that gelatin-thrombin matrix is a safe and both a clinically effective and costsaving means of treating posterior epistaxis. In this study, its use is associated with a low level of discomfort. This treatment method may improve the quality of care for patients with posterior epistaxis.

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Endoscopic Ligation of the Sphenopalatine Artery and the Maxillary Artery for the Treatment of Intractable Posterior Epistaxis

Cited by 33 publications

References 11 publications

Landmarks for Rapid Localization of the Sphenopalatine Foramen: A Radiographic Morphometric Analysis

Landmarks for Rapid Localization of the Sphenopalatine Foramen: A Radiographic Morphometric Analysis

Sphenopalatine artery surgery for refractory idiopathic epistaxis: Systematic review and meta‐analysis

Prospective clinical trial of gelatin‐thrombin matrix as first line treatment of posterior epistaxis

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