Comparative Study between Transnasal Endoscopic Sphenopalatine Artery Ligation and Cauterization in Posterior Epistaxis

Document Type : Original Article

Authors

1 Department of Otorhinolaryngology, Damietta Faculty of Medicine, Al-Azhar University, Egypt

2 Department of Otorhinolaryngology, Faculty of Medicine, Al-Azhar University, Egypt

Abstract

Background: Epistaxis is the commonest otorhinolaryngological emergency. Anterior epistaxis usually responds to conservative treatment. But, treatment of posterior epistaxis is challenging.
Aim of the work: The current study aimed to compare between transnasal endoscopic sphenopalatine artery ligation [TESPAL] and cauterization for control of posterior epistaxis.
Patients and Methods: Fourty patients with posterior epistaxis were included. They were randomly classified into two equal groups. The first [group A] for treatment by transnasal endoscopic sphenopalatine artery ligation. The second [group B] for treatment by transnasal endoscopic sphenopalatine artery cauterization. They were evaluated by history taking, clinical examination and routine laboratory investigations. After surgery, routine follow up consisted of anterior rhinoscopy and endoscopic nasal examination weekly during the first month then monthly up to 6 months. Postoperative complications such as recurrent epistaxis, nasal crustation, synechia, sinusitis and paresthesia in soft palate or nose were recorded.
Results: Both groups were comparable regarding patient age, gender [with overall male gender predominance] and associated complications. The majority of epistaxis was from the right side, and only one patient [5%] in each group presented by bilateral epistaxis. The majority were of idiopathic etiology. The majority of operation approached two branches of SPA [60% vs 65% of ligation and cauterization groups respectively]. The duration of surgery was shorter in ligation than cauterization [58.0±14.4 vs 61.5±13.9 minutes respectively]. However, the difference was statistically non-significant. Hospital stay duration also was comparable between both groups. The success rate was 85.0% and 80.0% in ligation and cauterization groups respectively and no significant difference was observed. Nasal crustation was significantly associated with cauterization [30.0%] than ligation [5.0%].
Conclusion: Although both ligation and cauterization were comparable as overall results. Ligation is superior in overall success rate and significantly associated with low crustation. This favors SPA ligation than cauterization. However, future studies are warranted. 

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