Sphenopalatine Artery Ligation

A 70-year-old male presented with persistent left-sided epistaxis, occurring 4 – 12 times a day for 3 weeks. Episodes lasted 10 – 15 minutes, but once required nasal packing at the ED.

Introduction: Ligation of the sphenopalatine artery is often indicated for patients with persistent posterior epistaxis that cannot be attributed to other causes. This video demonstrates a step-wise endoscopic sphenopalatine artery ligation using hemoclips.

Methods: In order to access the maxillary sinus cavity, a ball-tip probe was used to fracture the uncinate and a backbiter was used to remove the uncinate in its entirety. Once in the maxillary sinus, a backbiter was used to remove the tissue anterior to the normal ostium. A straight Tru-Cut was used to remove tissue posterior the natural ostium, taking down the posterior fontanelle. After this was done, a down-biter and a microdebrider blade were used to remove tissue inferior to the natural ostium towards the inferior turbinate. A caudal instrument was used to raise a subperiosteal flap just posterior to the left maxillary sinus posterior wall. Next, dissection from the inferior turbinate up to the top of the maxillary sinus was done from an inferior to superior direction, roughly 1 cm posterior to the posterior wall of the maxillary sinus. The sphenopalatine artery was seen coming out of the sphenopalatine foramen and soft tissue was dissected off this artery. Two hemoclips were placed over the entire artery.

Results: The patient was sent to recovery in good condition and no adverse reactions were reported by the surgeon or patient.

Surgeons: Alissa Kanaan, MD. Zachary V. Anderson, MD.

Institution: Department of Otolaryngology – Head and Neck Surgery at the University of Arkansas for Medical Sciences.

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