title: Comparison of internal maxillary artery ligation versus embolization for refractory posterior epistaxis.
abstract: OBJECTIVE
  This study examined the advantages and disadvantages of internal maxillary artery (IMA) ligation versus embolization for the treatment of refractory posterior epistaxis.
  
  
  METHODS
  Thirty-nine patients underwent 42 procedures for treatment of posterior epistaxis at the University of Cincinnati Medical Center between 1986 and 1994. Complication rates, failure rates, demographics, and the costs of IMA ligation and embolization were compared. A review of 20 studies published between 1973 and 1995 was done to determine the complication and failure rates of IMA ligation and embolization. Finally, a mail survey was used to determine the availability and use of IMA ligation and embolization by urban and rural otolaryngologists in Ohio.
  
  
  RESULTS
  Complication and failure rates of IMA ligation and embolization were similar at our institution. In the literature review, IMA ligation had a higher complication rate, but fewer failures. Although the major complication rates were not significantly different, those associated with embolization were often more serious than those associated with IMA ligation. At our institution, the cost of IMA embolization was significantly lower than the cost of IMA ligation. Only 11% of Ohio otolaryngologists in nonurban areas have embolization available to treat posterior epistaxis.
  
  
  CONCLUSIONS
  IMA ligation is more effective than IMA embolization but may be associated with a higher minor complication rate. The major complications that occur with IMA embolization are often more serious. Although IMA embolization was less expensive at our institution, it is unavailable in most nonurban regions in Ohio. Training in the use of IMA ligation for refractory posterior epistaxis should continue in otolaryngology residency training programs despite the increasing availability of embolization at university training centers.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati Medical Center, Ohio 45267, USA.
authors.forename: M M
authors.initials: MM
authors.lastname: Cullen
authors.forename: T A
authors.initials: TA
authors.lastname: Tami
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D003362:Cost-Benefit Analysis; D003710:Demography; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000191:economics; D004844:Epistaxis / Q000601:surgery / Q000628:therapy*; D005260:Female; D017048:Health Care Costs; D006297:Health Services Accessibility; D006801:Humans; D007396:Internship and Residency; D008026:Ligation / Q000009:adverse effects / Q000191:economics; D008297:Male; D008438:Maxillary Artery / Q000601:surgery*; D008875:Middle Aged; D009820:Ohio; D010036:Otolaryngology / Q000193:education; D012008:Recurrence; D012189:Retrospective Studies; D019035:Rural Health Services; D011795:Surveys and Questionnaires; D017211:Treatment Failure; D019037:Urban Health Services