Abstract
BackgroundSevere epistaxis is one of the most common emergencies in rhinology practices. The commonly used endoscopic cauterization of the sphenopalatine artery (SPA), alone or with the anterior ethmoidal artery (AEA), has a high success rate for controlling severe epistaxis. The current study was conducted to evaluate the endoscopic intra-operative variations of SPA between epistaxis and non-epistaxis cases. Forty consecutive patients who underwent exploration of SPA were included in the study. They were distributed into two groups depending upon the indication of SPA exploration; the epistaxis group (group A, n=25 patients, n=26 sides) and the non-epistaxis group (group B, n=15 patients, n=25 sides). Criteria of the main SPA in the two groups were compared regarding four parameters; arterial diameter, arterial adherence to the mucosa of the lower part of the basal lamella, sphenopalatine nerve bundle, and crista ethmoidalis erosion.ResultsA significant difference was found regarding the diameter of SPA between the two groups; a mean diameter of 4.2±0.64 mm was compared to 3.2±0.35 mm for group A and B, respectively (p=0.043). Moreover, a highly significant tendency was observed regarding the arterial adherence to the mucosa of the lower part of the basal lamella and sphenopalatine nerve bundle in the epistaxis group; (p≤0.01).ConclusionThese data clearly signify the importance of intraoperative identification of SPA criteria during surgical management of severe epistaxis. These criteria may help in altering the surgical decision between solely SPA and concomitant SPA/AEA cauterization.
Highlights
IntroductionThe commonly used endoscopic cauterization of the sphenopalatine artery (SPA), alone or with the anterior ethmoidal artery (AEA), has a high success rate for controlling severe epistaxis
Severe epistaxis is one of the most common emergencies in rhinology practices
The key for the efficient control of severe epistaxis is the accurate identification of bleeding source that is necessary for selecting the appropriate management procedure [5, 6, 12,13,14]
Summary
The commonly used endoscopic cauterization of the sphenopalatine artery (SPA), alone or with the anterior ethmoidal artery (AEA), has a high success rate for controlling severe epistaxis. The lack of a universal management protocol and the difficulty to identify the bleeding source, in most cases of severe epistaxis [1, 2], have given rise to many surgical paradigms targeting the empirical ligation and/or cauterization of main feeding. The endoscopic ligation and/or cauterization of SPA and its terminal branches has been the commonly used surgical procedure for controlling severe epistaxis. The key for the efficient control of severe epistaxis is the accurate identification of bleeding source that is necessary for selecting the appropriate management procedure [5, 6, 12,13,14]
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