Sphenopalatine artery ligation: technical note

2005 ◽  
Vol 119 (10) ◽  
pp. 810-812 ◽  
Author(s):  
David D Pothier ◽  
Samuel MacKeith ◽  
Robin Youngs
Keyword(s):  
Surgical Technique ◽  
Surgical Management ◽  
Nasal Mucosa ◽  
Lateral Wall ◽  
First Aid ◽  
Technical Note ◽  
Review Of The Literature ◽  
Artery Ligation ◽  
Sphenopalatine Artery ◽  
Sphenopalatine Foramen

Epistaxis is a common problem. Most patients presenting to hospital will stop bleeding with simple first-aid measures or with nasal packing. Those who do not stop will usually require surgical management. For persistent posterior epistaxis, the sphenopalatine artery may be ligated as the artery leaves the sphenopalatine foramen to enter the nasal mucosa of the lateral wall of the nose. This may be performed endoscopically. We describe the anatomy of the area and the surgical technique. We also present a brief review of the literature on this technique.

Cytologic Alterations in Nasal Mucosa after Sphenopalatine Artery Ligation in Patients with Vasomotor Rhinitis

2012 ◽  
Vol 26 (1) ◽  
pp. 49-54 ◽  
Author(s):  
Michele Cassano ◽  
Luigi Russo ◽  
Alessandro Maselli Del Giudice ◽  
Matteo Gelardi
Keyword(s):  
Nasal Mucosa ◽  
Vasomotor Rhinitis ◽  
Artery Ligation ◽  
Sphenopalatine Artery

Endoscopic sphenopalatine artery ligation for acute idiopathic epistaxis. Do anatomical variation and a limited evidence base raise questions regarding its place in management?

2017 ◽  
Vol 131 (4) ◽  
pp. 290-297 ◽  
Author(s):  
A Ellinas ◽  
P Jervis ◽  
G Kenyon ◽  
L M Flood
Keyword(s):  
Surgical Management ◽  
Anatomical Variation ◽  
Case Series ◽  
Evidence Base ◽  
Limited Evidence ◽  
Artery Ligation ◽  
Sphenopalatine Artery ◽  
Anatomical Basis ◽  
High Level ◽  
New Procedures

AbstractBackground:Endoscopic sphenopalatine artery ligation is widely accepted as effective and safe for acute spontaneous epistaxis that is unresponsive to conservative management. As with many new procedures, it has been progressively adopted as common practice, despite a limited evidence base for its efficacy. Early reviews called for comparative trials to support its adoption, but subsequent literature largely consists of case series and narrative reviews. These have attempted to derive an algorithm to establish its place in management, but consensus is still lacking. Intuitively, although there are theoretical objections, an operation regarded as relatively simple, fast and safe hardly seems to demand high-level evidence of efficacy. Rhinologists may be influenced by years of personal experience and success with the technique. However, estimates of the effect size and the added contribution to traditional surgical management are lacking. If the procedure could be shown to dramatically influence outcome, it should be standard practice and indispensable for all patients requiring operative intervention.Objectives:This paper systematically examined the literature, appraising the anatomical basis for such an approach and evidence for its efficacy. It questions whether any units unable to consistently offer endoscopic sphenopalatine artery ligation should be undertaking surgical management of acute epistaxis.

Surgical and interventional radiological management of adult epistaxis: systematic review

2017 ◽  
Vol 131 (12) ◽  
pp. 1108-1130 ◽  
Author(s):  
C Swords ◽  
A Patel ◽  
M E Smith ◽  
R J Williams ◽  
I Kuhn ◽  
...  
Keyword(s):  
Systematic Review ◽  
Adverse Effect ◽  
Interventional Radiology ◽  
Search Strategy ◽  
Database Search ◽  
Economic Effects ◽  
Success Rates ◽  
Review Of The Literature ◽  
Artery Ligation ◽  
Sphenopalatine Artery

AbstractBackground:There is variation regarding the use of surgery and interventional radiological techniques in the management of epistaxis. This review evaluates the effectiveness of surgical artery ligation compared to direct treatments (nasal packing, cautery), and that of embolisation compared to direct treatments and surgery.Method:A systematic review of the literature was performed using a standardised published methodology and custom database search strategy.Results:Thirty-seven studies were identified relating to surgery, and 34 articles relating to interventional radiology. For patients with refractory epistaxis, endoscopic sphenopalatine artery ligation had the most favourable adverse effect profile and success rate compared to other forms of surgical artery ligation. Endoscopic sphenopalatine artery ligation and embolisation had similar success rates (73–100 per cent and 75–92 per cent, respectively), although embolisation was associated with more serious adverse effects (risk of stroke, 1.1–1.5 per cent). No articles directly compared the two techniques.Conclusion:Trials comparing endoscopic sphenopalatine artery ligation to embolisation are required to better evaluate the clinical and economic effects of intervention in epistaxis.

scholarly journals Landmarks for Rapid Localization of the Sphenopalatine Foramen: A Radiographic Morphometric Analysis

2017 ◽  
Vol 8 (2) ◽  
pp. ar.2017.8.0196 ◽  
Author(s):  
Anne K. Maxwell ◽  
Henry P. Barham ◽  
Anne E. Getz ◽  
Todd T. Kingdom ◽  
Vijay R. Ramakrishnan
Keyword(s):  
Computed Tomography ◽  
Statistical Analysis ◽  
Standard Deviation ◽  
Morphometric Analysis ◽  
Middle Turbinate ◽  
Artery Ligation ◽  
Sphenopalatine Artery ◽  
Sphenopalatine Foramen ◽  
Nasal Floor ◽  
The Mean

Background Transnasal endoscopic sphenopalatine artery ligation is becoming the procedure of choice for surgical management of intractable posterior epistaxis. Landmarks for localization of the sphenopalatine foramen can assist in rapid surgical exposure of the sphenopalatine artery. Objective This study examined distances from easily identified endoscopic surgical landmarks to the sphenopalatine foramen. Methods By using computed tomography of the sinus to study radiologic anatomy in 50 adults, distances were measured between five simple endoscopic landmarks and the sphenopalatine foramen. The two-tailed t-test was used for statistical analysis. Results Right- and left-sided measurements were similar. The mean (standard deviation [SD]) anteroposterior distances to the sphenopalatine foramen were the following: from the maxillary line (36.7 ± 5.5 mm), anterior head of the middle turbinate (33.8 ± 6.7 mm), basal lamella (11.8 ± 1.9 mm), and choanal arch (–9.2 ± 1.4 mm). The mean (SD) distance in the vertical dimension from the nasal floor was 26.6 ± 2.6 mm. Female patients had statistically shorter distances to the sphenopalatine foramen from the maxillary line, anterior head of the middle turbinate, choanal arch, and nasal floor. Conclusion Reliable endoscopic landmarks exist in relation to consistent anatomic structures and can be used to help quickly estimate the location of the sphenopalatine foramen at the onset of the procedure.

Surgical Management of Trigeminal Neuralgia Induced by Brainstem Infarct: A Systematic Review of the Literature

2021 ◽  
Author(s):  
Rachyl M. Shanker ◽  
Miri Kim ◽  
Chloe Verducci ◽  
Elhaum G. Rezaii ◽  
Kerry Steed ◽  
...  
Keyword(s):  
Systematic Review ◽  
Trigeminal Neuralgia ◽  
Surgical Management ◽  
Review Of The Literature

scholarly journals Endoscopic Sphenopalatine Artery Ligation: General Applicability in a Teaching Unit

2019 ◽  
Vol 98 (2) ◽  
pp. 85-88 ◽  
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.

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