Endonasal coagulation of the sphenopalatine artery in severe posterior epistaxis

Laryngo- rhino- otologie
H Rudert, S Maune

Abstract

Until a few years ago the surgical method of choice in treating uncontrollable nosebleeds from the posterior part of the nose was the transantral ligation of the maxillary artery as described by Seiffert (Caldwell-Luc approach). We introduce a surgical method to expose and coagulate the sphenopalatine artery through an endonasal approach. The middle meatus of the nose is exposed with a self supporting nasal speculum under the microscope (focus: 300 mm) and the maxillary sinus is opened through the posterior fontanelle. The medial wall of the maxillary sinus is removed from this opening to its end. Three to five millimeters posterior to this site, the foramen sphenopalatinum is exposed. The osseous lateral margin of the foramen is resected with the drill and the fossa pterygopalatina is thereby opened from the nose. The sphenopalatine artery can be exposed all the way to its origin from the maxillary artery and then coagulated. Thirty-one patients with severe epistaxis have been operated by this method since October 1993. No postoperative complications were observed in any cases. Thirty patients have had no further nosebleed since than (average follow-up 22.9 months). In one case of a patient with renal insufficiency a nose blee...Continue Reading

Citations

Dec 6, 2005·ORL; Journal for Oto-rhino-laryngology and Its Related Specialties·Markus ZähringerKlaus Lackner

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