The Surgical Management of Massive Epistaxis

The use of angiography in a case of recurrent epistaxis after multiple arterial ligation

“…The role of arterial ligation in persistent epistaxis has been well documented by previous authors (Malcomson, 1963;Hunter and Gibson, 1969). If the bleeding is seen to be from the anterior ethmoidal artery alone, ligation of this vessel is indicated.…”

“…The latter may be occluded in the neck (Barrett and Orr, 1908), or the internal maxillary artery may be ligated in the pterygornaxillary fissure (Seiffert, 1928). By the use of one or other of these techniques epistaxes which fail to respond to conservative treatment can usually be arrested (Malcomson, 1963). However, Malcomson described 1 personal case which had persistent epistaxis after ligation of the internal maxillary and anterior ethmoidal arteries.…”

Die perkutane Embolisationstherapie bei therapierefraktärer, nicht-traumatischer Epistaxis

“…Die klassische Therapieform der unstillbaren Blutung nach Versagen der hinteren Tamponade bei idiopathischer Epistaxis war bislang die Ligatur der A. maxillaris interna [5,11,20]. So wird die Ligatur der A. maxillaris auch heute noch vielerorts als Methode der 1.…”

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

“…With the widespread adoption of endoscopic surgery for evaluation of the nose and sinus surgery, the currently preferred method for controlling persisting epistaxis is ligation of, or diathermy to, the sphenopalatine artery in the nose. This approach was advocated as long ago as 1963, when Malcomson wrote that ‘the sphenopalatine artery may be ligated as a secondary procedure, when primary ethmoidal occlusion fails to stop the bleeding; the sphenopalatine foramen and artery are exposed via the ethmoidal labyrinth.’ 3 Further, as the rigid endoscope superseded the operating microscope, the first reports of a truly transnasal approach to the sphenopalatine artery appeared (in 1992) 4 …”