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

Abstract

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

Analysis of Endoscopic Sphenopalatine Artery Surgery for Refractory Epistaxis

“…The surgical success rate was 89% (25/28 cases); this result is comparable to that obtained in previous studies [1]…”

“…Generally, anterior epistaxis is easy to control with observation or anterior gauze packing, whereas posterior epistaxis is often refractory to conservative treatment (i.e., anterior or posterior nasal packing) and sometimes recurs. Internal maxillary artery or external carotid artery operations without an endoscope for nasal bleeding have been performed [1]. Internal maxillary artery surgery requires a Caldwell-Luc procedure to be performed as the first step, which results in cheek pain in many cases.…”

Epistaxis in dental and maxillofacial practice: a comprehensive review

“…Administration of systemic antibiotics is recommended while anterior and posterior packing are maintained 3 , 37 . In cases of severe intractable epistaxis with repeated failure of packing insertions, cauterization-clipping of the sphenopalatine artery following endonasal endoscopy is performed under general anesthesia 38 , at which time, bleeding sites can be cauterized, spurs can be removed, and a deviated septum can be straightened. Another valuable tool to control severe epistaxis is angiography, which involves embolization of the internal maxillary artery ( Fig.…”

Trans-nasal Endoscopic Sphenopalatine Artery Ligation in Epistaxis: Coblation Versus Electrocauterization

“…In systematic review by Kitamura et al the pooled complication rate in the cauterization group was 10.2% (95% CI, 3.8-214.5), whereas the rate in the ligation group was6.4% (95% CI, 1.8-20.9) [14].…”