Ethmoidal Arteries Ligation for Epistaxis

Overview

Ethmoidal arteries ligation is a surgical procedure used to control severe or recurrent epistaxis (nosebleed) by ligating the ethmoidal arteries that supply the nasal cavity.

Anatomy of the Ethmoidal Arteries

The ethmoidal arteries are branches of the ophthalmic artery and include:

1. Anterior ethmoidal artery

Supplies the anterior part of the nasal septum and lateral nasal wall.
2. Posterior ethmoidal artery

Supplies the posterior part of the nasal septum and lateral nasal wall.

Anatomical Variations

Anatomical variations of the ethmoidal arteries can occur, and it's essential to identify these variations preoperatively to avoid complications.

Indications

1. Severe or recurrent epistaxis

When conservative measures fail to control bleeding.
2. Failed nasal packing or cauterization

When other treatments are ineffective.

Preoperative Investigations

Imaging studies

CT or MRI scans may be used to assess the nasal cavity and sinuses.

Preoperative Preparation

1. Antibiotics

May be administered to prevent infection.
2. Tranexamic acid

May be used to reduce bleeding.
3. Blood transfusion

May be necessary if significant blood loss has occurred.

Operative Process

Anesthesia

The procedure is typically performed under general anesthesia.

Position of Patient

The patient is positioned in a supine position with the head elevated.

Types of Endoscope

0-degree endoscope

Provides a direct view of the nasal cavity.
30-degree endoscope

Offers a wider field of view and is useful for visualizing the ethmoidal arteries.

Procedure

1. Uncinectomy

Removal of the uncinate process to access the ethmoidal artery.
2. Bullectomy

Removal of the ethmoidal bulla to access the posterior ethmoidal artery.
3. Middle meatal antrostomy

Creation of an opening in the middle meatus to access the ethmoidal arteries.
4. Localization of the ethmoidal arteries

Identification of the anterior and posterior ethmoidal arteries.
5. Ligation of the arteries

Clipping or cauterization of the ethmoidal arteries.

Management

Postoperative Management

1. Nasal packing

May be used to control bleeding and support the nasal mucosa.
2. Monitoring

Close monitoring of the patient's vital signs and nasal bleeding.
3. Nasal irrigation

Saline irrigation may be used to keep the nasal cavity clean and promote healing.
4. Intranasal corticosteroids

May be used to reduce inflammation and promote healing.
5. Liquid paraffin

May be applied to the nasal cavity to prevent crusting and promote healing.

Open Approach Compared to Endoscopy

Endoscopy is generally preferred over open approaches due to its minimally invasive nature and reduced risk of complications.

Contraindications to Endoscopic SPAL

1. Severe nasal septal deviation

May make it difficult to access the ethmoidal arteries.
2. Nasal tumors or masses

May obstruct the view or make it difficult to access the arteries.
3. Previous nasal surgery

May make the procedure more challenging due to altered anatomy.

Ethmoidal arteries ligation is an effective procedure for controlling severe or recurrent epistaxis. Proper preoperative preparation, surgical technique, and postoperative management are essential for optimal outcomes.

Want to Know More of

Epistaxis

Nosebleeds (epistaxis) can be alarming, but most cases can be managed with simple first aid. Here’s what you need to know. . . . . . . . . . . . . . . . . . . . .

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