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Combined internal maxillary and anterior ethmoidal arterial occlusion: the treatment of choice in intractable epistaxis

Published online by Cambridge University Press:  29 June 2007

Bharath Singh  and
M. Med
Bharath Singh*
Affiliation:
OTOLCongella, South Africa
M. Med
Affiliation:
OTOLCongella, South Africa
*
B. Singh, Department of Otorhinolaryngology, Faculty of Medicine, University of Natal, P. O. Box 17039, Congella, 4013, South Africa.
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Abstract

Whilst it is generally accepted that the standard management for anterior or benign epistaxis is either cautery or anterior nasal packing, that of posterior or intractable epistaxis remains controversial. Various modalities of treatment, ranging from posterior nasal packing to arterial ligation and embolization, have been advocated but none have been unanimously accepted as the treatment of choice.

The purpose of this paper was to determine the efficacy of internal maxillary arterial ligation versus combined internal maxillary arterial ligation and anterior ethmoid arterial coagulation in intractable epistaxis.

Over a six year period, from 1985 to 1990,454 patients were admitted and treated for epistaxis. Forty-seven patients were diagnosed as having intractable epistaxis on the basis that the epistaxis failed to settle on anterior nasal packing. They were moved to the next step in management, which was combined anterior and posterior nasal packing. There were 30 failures, one was found to have choriocarcinoma of the maxilla, and was treated wtih cytotoxics, and the other 29 were moved to the next step, which was arterial ligation. Fifteen patients had internal maxillary arterial ligation, and 14 combined internal maxillary arterial ligation and anterior ethmoidal arterial coagulation.

Large windows were created in both the anterior and posterior walls of the maxillary sinuses and all identifiable branches of the internal maxillary artery were dissected out carefully and two medium size ligating clips were placed over the main trunk, the sphenopalatine and the descending palatine branches. Single clips were placed on all other identifiable branches. Coagulation of the anterior ethmoidal artery was performed with a bipolar cautery. There were three (20 per cent) failures in the internal maxillary arterial ligation group and none in the combined internal maxillary arterial ligation and anterior ethmoidal arterial coagulation group. Furthermore, the three failures were successfully treated with anterior ethmoidal arterial coagulation. The conclusion is that combined internal maxillary and anterior ethmoidal arterial occlusion is the treatment of choice in intractable epistaxis.

Keywords

EpistaxisArterial occlusion
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 106 , Issue 6 , June 1992 , pp. 507 - 510
Copyright
Copyright © JLO (1984) Limited 1992

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References

Allen, G. W. (1970) Ligation of internal maxillary artery for epistaxis. Laryngoscope, 80: 915–923.CrossRefGoogle ScholarPubMed
Cassisi, N. J., Biller, H. R. Ogura, J.H. (1971) Changes in arterial oxygen tension and pulmonary mechanics with the use of posterior packing in epistaxis: A preliminary report. Laryngoscope, 81: 1261–1266.CrossRefGoogle ScholarPubMed
Cooke, E. T. M. (1985) An evaluation and clinical study of severe epistaxis treated by arterial ligation. Journal of Laryngology and Otology, 99: 745–749.CrossRefGoogle ScholarPubMed
Golding-Wood, P. H. (1983) The role of arterial ligation in intractable epistaxis. Journal of Laryngology and Otology, Supplement 8: 120–122.Google ScholarPubMed
Hara, H. J. (1962) Severe epistaxis. Archives of Otolaryngology, 75: 258–269.CrossRefGoogle ScholarPubMed
Hicks, J. N., Vitek, G. (1989) Transarterial embolization to control posterior epistaxis. Laryngoscope, 99: 1027–1029.CrossRefGoogle ScholarPubMed
Hunter, K., Gibson, R. (1969) Arterial ligation for severe epistaxis. Journal of Laryngology and Otology, 83: 1099–1103.CrossRefGoogle ScholarPubMed
Juselius, H. (1974) Epistaxis a clinical study of 1724 patients. Journal of Laryngology and Otology, 88: 317–327.CrossRefGoogle Scholar
Kuhn, A. J., Hallberg, O. E. (1955) Complications of postnasal packing for epistaxis. Archives of Otolarynology, 62: 62–65.CrossRefGoogle ScholarPubMed
McDonald, T. J., Pearson, B. W. (1980) Follow-up on maxillary artery ligation for epistaxis. Archives of Otolaryngoloqy, 106: 635–638.CrossRefGoogle ScholarPubMed
Metson, R., Lane, R. (1988) Internal maxillary artery ligation for epistaxis: an analysis of failures. Laryngoscope, 98: 760–764.CrossRefGoogle ScholarPubMed
Montgomery, W. W., Lofgren, R. H., Chasin, W. D. (1970) Analysis of pterygopalatine space surgery. Larynoscope, 80: 1190–1200.CrossRefGoogle ScholarPubMed
Montgomery, W. W., Reardon, E. J. (1980) Early vessel ligations for control of severe epistaxis. In Controversies in otolaryngologv. W. B. Saunders: Philadelphia, p. 315–319.Google Scholar
Nair, K. K. (1982) Transantral ligation of the internal maxillary artery. Laryngoscope, 92: 1060–1063.CrossRefGoogle ScholarPubMed
Procino, N. D. (1978) Treatment of posterior epistaxis. Ear, Nose and throat Journal, 57: 305–309.Google ScholarPubMed
Rosnagle, R. S., Yanagisawa, E., Smith, H. W. (1973) Specific vessel ligation for epistaxis. Survey of 60 cases. Laryngoscope, 83: 517–525.CrossRefGoogle ScholarPubMed
Schaitkin, B., Strauss, M., Houck, J. R. (1987) Epistaxis: medical versus surgical therapy. A comparison of efficacy, complications, and economic considerations. Laryngoscope, 97: 1392–1396.CrossRefGoogle ScholarPubMed
Shaheen, O. H. (1975) Arterial epistaxis. Journal of Laryngology and Otology, 89: 17–34.CrossRefGoogle ScholarPubMed
Small, M., Maran, A. G. D. (1984) Epistaxis and arterial ligation. Journal of Laryngology and Otology, 98: 281–284.CrossRefGoogle ScholarPubMed
Sokoloff, J., Wickbom, L., McDonald, D., Brahme, F. Goergen, T. G., Goldberger, L. E. (1974) Therapeutic percutaneous embolization in intractable epistaxis. Radiology, 111: 285–287.CrossRefGoogle ScholarPubMed
Strutz, J., Schumacher, M. (1990) Uncontrollable epistaxis. Angiographic localization and embolization. Archives of Otolarvngology, 116: 697–699.CrossRefGoogle ScholarPubMed
Van Wyck, L. G., Vinuela, F. Heenemann, H. (1982) Therapeutic embolization for severe epistaxis. Journal of Otolaryngologv, 11: 271–274.Google ScholarPubMed
Wang, L., Vogel, D. H. (1981) Posterial epistaxis: comparison of treatment. Otolaryngology–Head and Neck Surgery, 89: 1001–1006.CrossRefGoogle Scholar
Weddell, G., Macbeth, R. G., Sharp, H. S., Calvert, C. A. (1946) The surgical treatment of severe epistaxis in relation to ethmoidal arteries. British Journal of Surgery, 33: 387–392.CrossRefGoogle Scholar