Endoscopic sphenopalatine artery ligation for acute idiopathic epistaxis. Do anatomical variation and a limited evidence base raise questions regarding its place in management?

Ellinas, A; Jervis, P.; Kenyon, G; Flood, L M

doi:10.1017/s0022215117000214

Cited by 9 publications

(11 citation statements)

References 47 publications

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“…The ligation reduces the discomfort, cost and potential medical morbidity compared to nasal packing. 11,12,13,14,15,16 This procedure was first described by Prades J. 17 Endoscopic SPA ligation was first described by Budrovich and saetti in 1992.…”

Section: Discussionmentioning

confidence: 99%

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Endoscopic Sphenopalatine Artery Ligation in Posterior Epistaxis

Sigdel¹

2020

Nep J Med Sci

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Introduction: Posterior epistaxis brings us with a more challenging condition that can even threaten the life of a patient. Approaching the posterior nasal cavity is not an easy task because of its anatomical complexity and impending vision by turbinate. Increase endoscopic anatomic details of lateral nasal wall and endoscopic expertise with high definition camera leads to a higher success rate of endoscopic sphenopalatine artery ligation.Methods: This prospective study was conducted in patients with refractory posterior epistaxis between January 2017 to December 2019. All patient who had undergone Endoscopic Sphenopalatine artery ligation were included in this study. The site of bleeding was confirmed with the help of a rigid endoscope. Bipolar cauterization or clipping was performed to stop bleeding. Data analysis was done by using SPSS 26.0 version.Results: Twenty nine patients who had undergone Endoscopic sphenopalatine artery for posterior epistaxis were included during this study period. The mean age of the patient was 53.31 ± 18.65years. The site of bleeding was mostly from the left in 20 (75.9%) cases and 10 (34.4%) cases had severe bleeding that needed a blood transfusion. No recurrence of bleeding was found during follow up period. The severity of bleeding was significantly correlated with the age of patients (p<0.003). Out of 29 patient, 27 patients had undergone bipolar diathermy and 2 patients clipping was done.Conclusion: Sphenopalatine artery ligation is an effective management strategy for surgical control of refractory epistaxis. The early timing of sphenopalatine artery ligation may lead to reductions in length of stay.

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Section: Discussionmentioning

confidence: 99%

“…Increase endoscopic anatomic details of the lateral nasal wall leads to a higher success rate of endoscopic sphenopalatine artery ligation. 11,12 This study aims to observe the role of endoscopic sphenopalatine artery ligation in posterior epistaxis.…”

Section: Introductionmentioning

confidence: 99%

Endoscopic Sphenopalatine Artery Ligation in Posterior Epistaxis

Sigdel¹

2020

Nep J Med Sci

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“…They are easily accessible through the endoscopic nasal approach, and ligation or direct cauterization can be performed. This method is also less painful, more cost-effective, minimally invasive, and more clinically effective than others [14][15][16] . In our current case, endoscopy revealed bleeding in the posterior nasal artery, a branch of the sphenopalatine artery, and direct cauterization was performed.…”

Section: Discussionmentioning

confidence: 99%

An idiopathic delayed maxillary hemorrhage after orthognathic surgery with Le Fort I osteotomy: a case report

Park

Jang

Lee

2019

JKAOMS

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A Le Fort I osteotomy is a common procedure for correcting dental and facial deformities in orthognathic surgery. In rare cases, a delayed hemorrhage can occur as early as several hours or up to 12 weeks, postoperatively. The most frequently involved blood vessels in a delayed hemorrhage are the descending palatine artery, the internal maxillary artery, and the pterygoid venous plexus of veins. Intraoral bleeding accompanied by severe epistaxis in these cases makes it difficult to locate the precise bleeding focus. Eventual uncontrolled bleeding would require Merocel packing or surgical intervention. In general, a severe late postoperative hemorrhage is most effectively managed by angiography and embolization. Herein we describe a delayed hemorrhage case in which the cause was not evident on angiography. We were able to detect the bleeding point through an endoscopic nasal approach and treat it using direct cauterization.

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“…Typical is the place of sphenopalatine artery ligation as standard practice in the control of refractory epistaxis. Systematic review of the literature, however, highlights many persisting uncertainties 2 …”

Section: Introductionmentioning

confidence: 99%