The Wexham Criteria: defining severe epistaxis to select patients requiring sphenopalatine artery ligation

Background: Severe epistaxis is a frequent emergency condition encountered by otolaryngologists and is often treated with nasal packing. In the event of failure surgical treatment is considered. We aimed to evaluate the efficacy of Nasal Packing (NP) and Endoscopic Sphenopalatine Artery Ligation (ESPAL) as treatment of severe epistaxis in terms of failures and recurrences including risk factors. Methodology: Retrospective descriptive study of patients with epistaxis treated with NP, admitted to an ENT department from 2011-2017. If initial treatment with NP failed, patients were considered for ESPAL. Results: An analysis of 511 patients was performed. All patients were treated with NP at the time of admission, and 14% of pa- tients were treated with ESPAL due to failure of NP. The majority of patients was only admitted once. Twelve percent were readmit- ted within 30 days, 7% were readmitted >30 days later. Treatment failure after ESPAL was 7.9%. No significant difference in the risk of readmission was found between patients treated with NP alone and patients treated with ESPAL. Conclusion: The majority of epistaxis patients were effectively treated with NP alone. We found good effect of ESPAL although no significant differences in risk of readmission NP vs. ESPAL were identified.

Download Full-text

Arterial Ligation for Pediatric Epistaxis: Developmental Anatomy

American Journal of Rhinology ◽

10.1177/194589240301700202 ◽

2003 ◽

Vol 17 (2) ◽

pp. 75-81 ◽

Cited By ~ 22

Author(s):

Glenn Isaacson ◽

Janet M. Monge

Keyword(s):

Maxillary Artery ◽

Facial Growth ◽

Arterial Ligation ◽

Artery Ligation ◽

Developmental Anatomy ◽

Sphenopalatine Artery ◽

Dental Eruption ◽

Severe Epistaxis ◽

Feeding Vessels ◽

Ethmoidal Arteries

Background Anatomic studies of adult skulls have aided in the design of operations for the surgical ligation of nasal feeding vessels in the treatment of severe epistaxis. Lack of appropriate specimens has prevented similar studies in children. We performed an anthropometric study of archeological specimens to learn the effects of growth on key anatomic relationships. Methods We studied the skulls of children who died between 200 and 8000 years ago, recovered from archeological digs around the world. Measurements of the distances from the posterior lacrimal crest to the foramina of anterior and posterior ethmoidal arteries and optic canal and the pyriform aperture to the foramen of the sphenopalatine artery were made and compared with postnatal age, estimated from facial growth and dental eruption patterns. Results There is rapid growth in the orbit and midface during the first 6 years of life and gradual growth between 7 years and adulthood. The length of the medial wall of the orbit doubles during development with disproportionate enlargement of its anterior half. Conclusion Arterial ligation is sometimes required for intractable pediatric epistaxis, especially after trauma. The changing relationships of critical structures in the orbital must be understood to allow safe ethmoidal artery ligation. The transantral approach to the maxillary artery is greatly limited by lack of midfacial development and maxillary pneumatization. We describe the necessary parameters for endoscopic, transnasal sphenopalatine artery ligation in growing children.

Download Full-text

A Case of Severe Epistaxis during Pregnancy Treated by Sphenopalatine Artery Ligation

Korean Journal of Otorhinolaryngology - Head and Neck Surgery ◽

10.3342/kjorl-hns.2016.59.5.392 ◽

2016 ◽

Vol 59 (5) ◽

pp. 392

Author(s):

Hyunmo Kang ◽

Hyun-Jin Cho ◽

Sea-Yuong Jeon ◽

Sang-Wook Kim

Keyword(s):

Artery Ligation ◽

Sphenopalatine Artery ◽

Severe Epistaxis

Download Full-text

Endoscopic Sphenopalatine Artery Ligation: General Applicability in a Teaching Unit

Ear Nose & Throat Journal ◽

10.1177/0145561319828675 ◽

2019 ◽

Vol 98 (2) ◽

pp. 85-88 ◽

Cited By ~ 2

Author(s):

Shi Ying Hey ◽

Nigel K. F. Koo Ng ◽

Gerald W. McGarry

Keyword(s):

Grade Level ◽

Teaching Hospitals ◽

Artery Ligation ◽

General Applicability ◽

Sphenopalatine Artery ◽

The United Kingdom ◽

Simulation Based ◽

Teaching Unit ◽

Competency Based ◽

Nose And Throat

Background: Endoscopic sphenopalatine artery ligation (ESPAL) is the intervention of choice for refractory epistaxis in specialist ear, nose and throat (ENT)units and should be within the repertoire of competencies for all ENT trainees. Following its recent incorporation within the United Kingdom competency–based training syllabus as an explicit outcome standard, the ESPAL is not uncommonly being delivered by trainees under appropriate supervision. We assessed the efficacy and outcome of ESPAL in epistaxis management within our teaching hospitals. Methods: Retrospective, structured review of all ESPAL procedures performed for epistaxis between December 2005 and December 2013. The techniques of ligation, operator grade, and outcome were studied. Results: Sixty-five patients (41 male:24 female; average age of 58.2 years) were identified in whom 67 artery ligations were performed (63 unilateral; 2 bilateral). Overall, success rate of ESPAL was 92.3% (60/65), with 5 rebleed cases recorded within 30 days of the primary procedure. Sixteen (24.6%) underwent “clipping,” 26 (40.0%) had diathermy ligation, 18 (27.7%) had both clipping and diathermy, and in 5 (7.7%) patients, the ligation technique was not recorded. In 31 (47.7%) of 65 cases, a consultant was the principal surgeon. The remaining 34 (52.3%) of 65 cases were performed by trainees with (24, 70.6%) or without (10, 29.4%) supervision. There was no correlation between rebleed and operators’ grade, level of supervision, or ligation technique. Conclusion: With appropriate training, ESPAL can achieve hemostasis in teams of varying grades of operators without significant reduction in outcome. To further enhance the technical learning curve, the utility of simulation-based training could offer continuous and longitudinal development of skills.

Download Full-text

The Role of the Crista Ethmoidalis in Endoscopic Sphenopalatine Artery Ligation

American Journal of Rhinology ◽

10.2500/105065899782106814 ◽

1999 ◽

Vol 13 (2) ◽

pp. 81-86 ◽

Cited By ~ 36

Author(s):

William E. Bolger ◽

Roderick G. Borgie ◽

Patrick Melder

Keyword(s):

Artery Ligation ◽

Sphenopalatine Artery

Download Full-text

Success Rate of Endoscopic Sphenopalatine Artery Ligation for the Management of Refractory Posterior Epistaxis Patients in a Tertiary Care Hospital: A Descriptive Cross-sectional Study

Journal of Nepal Medical Association ◽

10.31729/jnma.5855 ◽

2020 ◽

Vol 58 (232) ◽

Author(s):

Meenakshi Basnet ◽

Bibek Ghimire ◽

Akriti Shrestha ◽

Gyan Raj Aryal

Keyword(s):

Success Rate ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Cross Sectional Study ◽

Medical Emergency ◽

Care Hospital ◽

Sectional Study ◽

Artery Ligation ◽

Cross Sectional ◽

Sphenopalatine Artery

Introduction: Epistaxis is a common medical emergency with 5% to 15% of patients admitted for epistaxis will require surgical management as nasal packing has high failure rates. A modern endoscopic technique like Endoscopic Sphenopalatine Artery Ligation has increased in popularity for managing intractable posterior epistaxis. It has less complication and a high success rate. The study conducted to estimate the success rate of Endoscopic Sphenopalatine Artery Ligation of refractory posterior epistaxis among admitted patients in a tertiary care hospital. Methods: This is a descriptive cross-sectional study conducted from June 2019 to June 2020 at the Department of Otorhinolaryngology, Nobel Medical College and Teaching Hospital among the patient with refractory posterior epistaxis with the help of retrospective data. A convenient sampling method was used. These patients underwent endoscopic sphenopalatine artery cauterization for recurrent/intractable posterior epistaxis. Ethical clearance was taken from the Institutional Review Board. Data were analyzed in Statistical Package for the Social Sciences. Results: Out of the total patient with refractory posterior epistaxis who underwent Endoscopic Sphenopalatine Artery Ligation, the overall success rate was 39 (95.12%). Among them, 25 (60.97%) males and 16 (39.02%) females underwent endoscopic sphenopalatine artery ligation. Twenty (48.78%) of them were unilateral whilst 21 (51.21%) were bilateral disease. About 2 (4.8%) cases had re-bleeding within 48 hours which was managed conservatively. Hypertension was found to be the most common comorbid condition followed by diabetes, chronic kidney. Conclusions: From our study, we conclude that the success rate for Endoscopic Sphenopalatine Artery Ligation in a patient with refractory posterior epistaxis was high.

Download Full-text