title: Posterior epistaxis: systematic review on the effectiveness of surgical therapies.
abstract: OBJECTIVE
  The optimal surgical treatment for patients with posterior epistaxis and failed conservative therapy is unknown. Therefore we planned a systematic review studying all available publications assessing the effect on bleeding recurrence and postoperative complications of ligation of the internal maxillary artery or the sphenopalatine artery.
  
  
  METHODS
  We searched the electronic databases Medline, Medline In Process, and Cochrane Library. Data extraction was performed following standard methods.
  
  
  RESULTS
  Twenty-eight studies could be included in the systematic review. All studies were retrospective and no single study comparing different methods could be identified. Fifteen studies reported on the effect of the ligation of the internal maxillary artery (LIMA) and 13 on the effect of the ligation of the sphenopalatine artery (LSA). The severity of postoperative complications and duration of hospital stay seem to be lower in the LSA group. A conclusive statement about the frequency of rebleeding in the two groups is not possible.
  
  
  CONCLUSIONS
  According to the available data on postoperative complications and duration of hospital stay ligation of the sphenopalatine artery compared favourably to the ligation of the internal maxillary artery. The most effective treatment for patients with posterior epistaxis including costs should be evaluated in a controlled clinical trial.
authors.affiliation: Horten Centre, University of Zurich, Switzerland.
authors.forename: Binja
authors.initials: B
authors.lastname: Feusi
authors.forename: David
authors.initials: D
authors.lastname: Holzmann
authors.forename: Johann
authors.initials: J
authors.lastname: Steurer
mesh_terms: D004844:Epistaxis / Q000601:surgery*; D006801:Humans; D008026:Ligation; D008438:Maxillary Artery / Q000601:surgery; D011183:Postoperative Complications; D012008:Recurrence; D012086:Reoperation; D013101:Sphenoid Sinus / Q000098:blood supply