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Posterior epistaxis: endonasal exposure and occlusion of the branches of the sphenopalatine artery


Holzmann, D; Kaufmann, T; Pedrini, P; Valavanis, A (2003). Posterior epistaxis: endonasal exposure and occlusion of the branches of the sphenopalatine artery. European Archives of Oto-Rhino-Laryngology, 260(8):425-428.

Abstract

Intractable posterior epistaxis (PE) is a frequent emergency for which different treatment modalities are available. While nasal packing causes extreme discomfort and angiography with consecutive selective embolization is not available everywhere, recent studies emphasize the value of sphenopalatine artery (SPA) occlusion by different techniques and indicate success rates of 13-33%. In our institution, previously endoscopic management of PE consisted either of isolated coagulation of an identified bleeding source (group A) or cutting and coagulation of arterial branches running through the sphenopalatine foramen (SPF) (group B). According to our neuroradiological and rhinological experience we developed a modification of SPA transsection and coagulation following identification of the division in conchal and septal branches of the SPA (group C). During a 26-month period the success rates of these three techniques in 95 patients were compared prospectively. The three modalities revealed a re-bleeding rate of 3 out of 21 (21%) in group A, 1 in 6 (16.7%) in group B and 3 in 69 (4.3%) in group C. At the level of the SPF, 36 out of 69 patients had one conchal branch, whereas 30 (43.5%) had two and 3 (4.4%) had three. If SPA transsection and coagulation for intractable PE is adopted the anatomic varieties of the SPA with its division in conchal and septal branches have to be taken into account. According to our experience the septal branch of the SPA plays a major role in PE. Its occlusion significantly improves the success rate of PE treatment.

Abstract

Intractable posterior epistaxis (PE) is a frequent emergency for which different treatment modalities are available. While nasal packing causes extreme discomfort and angiography with consecutive selective embolization is not available everywhere, recent studies emphasize the value of sphenopalatine artery (SPA) occlusion by different techniques and indicate success rates of 13-33%. In our institution, previously endoscopic management of PE consisted either of isolated coagulation of an identified bleeding source (group A) or cutting and coagulation of arterial branches running through the sphenopalatine foramen (SPF) (group B). According to our neuroradiological and rhinological experience we developed a modification of SPA transsection and coagulation following identification of the division in conchal and septal branches of the SPA (group C). During a 26-month period the success rates of these three techniques in 95 patients were compared prospectively. The three modalities revealed a re-bleeding rate of 3 out of 21 (21%) in group A, 1 in 6 (16.7%) in group B and 3 in 69 (4.3%) in group C. At the level of the SPF, 36 out of 69 patients had one conchal branch, whereas 30 (43.5%) had two and 3 (4.4%) had three. If SPA transsection and coagulation for intractable PE is adopted the anatomic varieties of the SPA with its division in conchal and septal branches have to be taken into account. According to our experience the septal branch of the SPA plays a major role in PE. Its occlusion significantly improves the success rate of PE treatment.

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18 citations in Web of Science®
29 citations in Scopus®
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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Otorhinolaryngology
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:2003
Deposited On:26 Mar 2009 09:47
Last Modified:05 Apr 2016 12:43
Publisher:Springer
ISSN:0937-4477
Publisher DOI:https://doi.org/10.1007/s00405-003-0618-7
PubMed ID:12720007

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