[Endonasal coagulation of the sphenopalatine artery in severe posterior epistaxis].

BACKGROUND: 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.

METHOD: 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.

RESULTS: 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 bleed occurred 15 day postoperatively following dialysis. It was controlled by ligation of the anterior ethmoid artery and of the peripheral branches of the external carotid artery.

CONCLUSION: The endonasal coagulation of the sphenopalatine artery is the safest method to control bleeding from the posterior parts of the nose. It can be performed by anyone who is familiar with endonasal surgery. The disadvantages of the transanteral ligation of the maxillary artery as described by Seiffert (Caldwell-Luc approach, ligation not sufficiently peripheral) are avoided. The only competing method would be the embolization of the sphenopalatine artery which can not be applied in every hospital and which has a higher complication and failure rate. Since October 1993 when this method was introduced no additional bellocq tamponade was required in epistaxis.