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Endoscopic sphenopalatine foramen cauterization is an effective treatment modification of endoscopic sphenopalatine artery ligation for intractable posterior epistaxis

  • Rhinology
  • Published:
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Abstract

Purpose

Endoscopic sphenopalatine artery ligation (ESPAL) is known as an effective treatment for posterior epistaxis. Anatomical variations of the intranasal branching may result in long operative time and possible inadequate cauterization. A modification of ESPAL by cauterization at the sphenopalatine foramen (SPF), has been performed by our group. Our study assessed the clinical benefit of endoscopic sphenopalatine foramen cauterization (ESFC) and compared it to ESPAL.

Method

A retrospective study was conducted. Patients who received ESFC for posterior epistaxis from 2016 to 2018 at a tertiary hospital were recruited. Middle meatal antrostomy was done. After ethmoidal crest was identified and nipped, pterygopalatine fossa was entered through the SPF. Sphenopalatine artery (SPA) and its branches within the SPF were cauterized without identification of any SPA distal branches in the nasal cavity. Patients receiving conventional ESPAL by the same surgeon were recruited and compared as control. Patients were followed-up for 3 months. Success rate, operative time, and complication were assessed.

Results

Thirty-four patients were identified. Recurrent epistaxis was absent in 90.0% and 100% of patients receiving ESPAL (9/10 patients) and ESFC (24/24 patients) respectively, p = 0.294. Median operative time was 115 and 60 min, respectively, p < 0.001. Ipsilateral hard palatal or anterior palatal numbness were found in one and three patients, respectively. All resolved spontaneously within 2 weeks.

Conclusion

ESFC is effective in treating posterior epistaxis. It requires significantly less amount of time while the success rate was comparable to conventional ESPAL.

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References

  1. Abdelkader M, Leong SC, White PS (2007) Endoscopic control of the sphenopalatine artery for epistaxis: long-term results. J Laryngol Otol 121:759–762

    Article  CAS  Google Scholar 

  2. Sharp HR, Rowe-Jones JM, Biring GS, Mackay IS (1997) Endoscopic ligation or diathermy of the sphenopalatine artery in persistent epistaxis. J Laryngol Otol 111:1047–1050

    Article  CAS  Google Scholar 

  3. O’Flynn PE, Shadaba A (2000) Management of posterior epistaxis by endoscopic clipping of the sphenopalatine artery. Clin Otolaryngol Allied Sci 25:374–377

    Article  Google Scholar 

  4. Snyderman CH, Goldman SA, Carrau RL, Ferguson BJ, Grandis JR (1999) Endoscopic sphenopalatine artery ligation is an effective method of treatment for posterior epistaxis. Am J Rhinol 13:137–140

    Article  CAS  Google Scholar 

  5. Kumar S, Shetty A, Rockey J, Nilssen E (2003) Contemporary surgical treatment of epistaxis. What is the evidence for sphenopalatine artery ligation? Clin Otolaryngol Allied Sci 28:360–363

    Article  CAS  Google Scholar 

  6. Traboulsi H, Alam E, Hadi U (2015) Changing trends in the management of epistaxis. Int J Otolaryngol 2015:263987

    Article  Google Scholar 

  7. Simmen DB, Raghavan U, Briner HR, Manestar M, Groscurth P, Jones NS (2006) The anatomy of the sphenopalatine artery for the endoscopic sinus surgeon. Am J Rhinol 20:502–505

    Article  Google Scholar 

  8. Budrovich R, Saetti E (1992) Microscopic and endoscopic ligature of the sphenopalatine artery. Laryngoscope 102:1390–1394

    Article  Google Scholar 

  9. Prades JM, Asanau A, Timoshenko AP, Faye MB, Martin C (2008) Surgical anatomy of the sphenopalatine foramen and its arterial content. Surg Radiol Anat 30:583–587

    Article  CAS  Google Scholar 

  10. Bolger WE, Borgie RC, Melder P (1999) The role of the crista ethmoidalis in endoscopic sphenopalatine artery ligation. Am J Rhinol 13:81–86

    Article  CAS  Google Scholar 

  11. Midilli R, Orhan M, Saylam CY, Akyildiz S, Gode S, Karci B (2009) Anatomic variations of sphenopalatine artery and minimally invasive surgical cauterization procedure. Am J Rhinol Allergy 23:e38–41

    Article  Google Scholar 

  12. Harvinder S, Rosalind S, Gurdeep S (2008) Endoscopic cauterization of the sphenopalatine artery in persistent epistaxis. Med J Malaysia 63:377–378

    CAS  PubMed  Google Scholar 

  13. Saraceni Neto P, Nunes LMA, Caparroz FAd, Gregorio LL, de Souza RPESF, Simões JC, Kosugi EM (2017) Resection of the ethmoidal crest in sphenopalatine artery surgery. Int Forum Allergy Rhinol 7:87–90

    Article  Google Scholar 

  14. Chandra RK, Rohman GT, Walsh WE (2008) Anterior palate sensory impairment after septal surgery. Am J Rhinol 22:86–88

    Article  Google Scholar 

  15. Langford RJ (1989) The contribution of the nasopalatine nerve to sensation of the hard palate. Br J Oral Maxillofac Surg 27:379–386

    Article  CAS  Google Scholar 

  16. Midilli R, Gode S, Ozturk K (2015) The “two-point” technique for endoscopic sphenopalatine artery cauterization: is it effective and safe? Hippokratia 19:284

    CAS  PubMed  PubMed Central  Google Scholar 

  17. Piastro K, Scagnelli R, Gildener-Leapman N, Pinheiro-Neto CD (2018) Outcomes of sphenopalatine and internal maxillary artery ligation inside the pterygopalatine fossa for posterior epistaxis. Rhinology 56:144–148

    Article  CAS  Google Scholar 

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Acknowledgements

We would like to thank Naret Taengyai, Head of Otolaryngology Division, Sawan Pracharak Hospital, for his technical advice and continued support.

Funding

Unfunded project. Wirach Chitsuthipakorn, Kachorn Seresirikachorn, and Dichapong Kanjanawasee have no financial disclosure. Kornkiat Snidvongs is a speaker at the Bureau for Merck Sharp Dolme, Menarini, and Meda.

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Authors and Affiliations

  1. Department of Otolaryngology, Sawanpracharak Hospital, Ministry of Public Health, Nakhon Sawan, Thailand

    Wirach Chitsuthipakorn

  2. Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

    Kachorn Seresirikachorn, Dichapong Kanjanawasee & Kornkiat Snidvongs

  3. Endoscopic Nasal and Sinus Surgery Excellence Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand

    Kachorn Seresirikachorn, Dichapong Kanjanawasee & Kornkiat Snidvongs

  4. Center of Excellence in Otolaryngology, Head and Neck Surgery, Rajavithi Hospital, Rangsit University, Bangkok, Thailand

    Wirach Chitsuthipakorn

Authors
  1. Wirach Chitsuthipakorn
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  2. Kachorn Seresirikachorn
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  3. Dichapong Kanjanawasee
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  4. Kornkiat Snidvongs
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by WC, KS, and KS. The first draft of the manuscript was written by WC and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Wirach Chitsuthipakorn.

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Conflict of interest

The authors, hereby, declare no conflict of interest.

Ethical approval

Sawanpracharak Hospital Ethics Committee, Approval No. 5/2561, 6th February, 2018.

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Electronic supplementary material

Below is the link to the electronic supplementary material.

VDO 1_ESPAL. The video of the conventional technique of Endoscopic Sphenopalatine Artery ligation (ESPAL). (MP4 70024 kb)

VDO 2_ESFC. The video of the Endoscopic Sphenopalatine Foramen Cauterization (ESFC). (MP4 75653 kb)

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Chitsuthipakorn, W., Seresirikachorn, K., Kanjanawasee, D. et al. Endoscopic sphenopalatine foramen cauterization is an effective treatment modification of endoscopic sphenopalatine artery ligation for intractable posterior epistaxis. Eur Arch Otorhinolaryngol 277, 2463–2467 (2020). https://doi.org/10.1007/s00405-020-06005-8

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  • DOI: https://doi.org/10.1007/s00405-020-06005-8

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