Management of intractable epistaxis in a tertiary care referral hospital: an observational study
DOI:
https://doi.org/10.18203/issn.2454-5929.ijohns20242041Keywords:
Epistaxis, Endoscopic sphenopalatine artery cauterization, Intractable epistaxis, Refractory epistaxis, Sphenopalatine arteryAbstract
Background: The aim of this study is to evaluate the effectiveness of sphenopalatine artery ligation/ cauterisation as a surgical intervention in control of refractory epistaxis and achieving haemostasis.
Methods: The study was done with patients in the Department of ENT, Head and Neck surgery Health care hospital and out station referrals from institution’s outreach clinics, for a period of 2 years (May 2020-April 2022). Patients with recurrent epistaxis, not controlled by digital pressure, anterior packing (ribbon gauze/ merocele) or postnasal packing were taken up for emergency endoscopic sphenopalatine artery ligation/cauterisation under general anaesthesia. Effectiveness of this technique was established by routine endoscopic follow up of these patients over a period of 6 months post procedure.
Results: Out of a total of 55 patients who presented with recurrent epistaxis, 8 patients settled down with conservative management (digital pressure/external ice pack application), 18 patients settled down with anterior nasal packing, 12 patients settled down with anterior and posterior nasal packing and 17 patients required sphenopalatine artery ligation/cauterization. None of these postop patients had any further episodes of nasal bleed.
Conclusions: Sphenopalatine artery ligation has proven to be an effective measure in control of intractable refractory epistaxis when compared to therapeutic embolization or other procedures.
References
Shah AG, Stachler RJ, Krouse JH. Endoscopic ligation of the sphenopalatine artery as a primary management of severe posterior epistaxis in patients with coagulopathy. ENT J. 2005;84(5):296-306.
Asanau A, Timoshenko AP, Vercherin P, Martin C, Prades JM. Sphenopalatine and anterior ethmoidal artery ligation for severe epistaxis. Ann Otol Rhinol Laryngol. 2009;118(9):639-44.
Nouraei SA, Maani T, Hajioff D, Saleh HA, Mackay IS. Outcome of Endoscopic Sphenopalatine Artery Occlusion for Intractable Epistaxis: A 10‐Year Experience. The Laryngoscope. 2007;117(8):1452-6.
Eladl HM, Elmorsy SM, Khafagy YW. Endoscopic devascularisation of sphenopalatine bundle in intractable posterior epistaxis: technique, efficacy and safety. J Laryngol Oto. 2011;125(11):1136-40.
Seno S, Arikata M, Sakurai H, Owaki S, Fukui J, Suzuki M. Endoscopic ligation of the sphenopalatine artery and the maxillary artery for the treatment of intractable posterior epistaxis. Am J Rhinol Allergy. 2009;23:197-9.
Holzmann D, Kaufmann T, Pedrini P. Posterior epistaxis: endonasal exposure and occlusion of the branches of the sphenopalatine artery. Eur Arch Otorhinolaryngol. 2003;260:425-8.
Wiorowski M, Schultz P, Perrot JB. Indications and results of cauterization by endoscopic approach of the sphenopalatine artery in severe posterior epistaxis. Auris Nasus Larynx. 2004;31:131-3.
Stankiewicz JA. Nasal endoscopy and control of epistaxis.Curr Opin Otolaryngol Head Neck Surg. 2004;12:43-5.
Snyderman CH, Goldman SA, Carrau RL. Endoscopic sphenopalatine artery ligation is an effective method of treatment for posterior epistaxis. Am J Rhinol. 1999;13:137-40.
Viducich RA, Blanda MP, Gerson LW. Posterior epistaxis: clinical features and acute complications. Annals of emergency medicine. 1995;25(5):592-6.
Koh E, Frazzini VI, Kagetsu NJ. Epistaxis: vascular anatomy, origins, and endovascular treatment. Am Jour Roentgenol. 2000;174(3):845-51.
Tan LK, Calhoun KH. Epistaxis. Med Clin North Am. 1999;83(1):43-56.
Pollice PA, Yoder MG. Epistaxis: A retrospective review of hospitalized patients. Otolaryngol Head and Neck Surg. 1995;113(2):58.
Klotz DA, Winkle MR, Richmon J, Hengerer AS. Surgical management of posterior epistaxis: a changing paradigm. The Laryngoscope. 2002;112(9):1577-82.
Schaitkin B, Strauss M, Houck JR. Epistaxis: medical versus surgical therapy: a comparison of efficacy, complications, and economic considerations. The Laryngoscope. 1987;97(12):1392-6.
Schaitkin B, Strauss M, Houck JR. Epistaxis: medical versus surgical therapy, a comparison of efficacy complications and economic considerations. Laryngoscope. 1987;97:1392-5.
Shaw CB, Wax MK, Wetmore SJ. Epistaxis: a comparison of treatment. Otolaryngol Head Neck Surg. 1993;109:60-5.
Spafford P, Durham JS. Epistaxis: efficacy of arterial ligation and long-term outcome. J Otolaryngol. 1992;21:252-6.
Sigdel B. Endoscopic Sphenopalatine Artery Ligation in Posterior Epistaxis. NJMS. 2020;5(2):10-5.
Hervochon R, Khoueir N, Le Clerc N, Clément J, Kania R, Herman P, et al. Unilateral vs bilateral sphenopalatine artery ligation in adult unilateral epistaxis: A comparative retrospective study in 83 cases. Clinical Otolaryngol. 2020;(43):1592-4.
Sharp HR, Rowe-Jones JM, Biring GS, Mackay IS. Endoscopic ligation or diathermy of the sphenopalatine artery in persistent epistaxis. JLO. 1997;111(11):1047-50.
Pritikin JB, Caldarelli DD, Panje WR. Endoscopic ligation of the internal maxillary artery for treatment of intractable posterior epistaxis. JLO. 1998;107(2):85-91.
Srinivasan V, Sherman IW, O’sullivan G. Surgical management of intractable epistax is: audit of results. JLO. 2000;114(9):697-700.
