title: Endoscopic ligation of the sphenopalatine artery and the maxillary artery for the treatment of intractable posterior epistaxis.
abstract: BACKGROUND
  Intractable posterior epistaxis sometimes requires intensive treatment, such as surgery or embolization. Maxillary artery ligation has been widely used for the treatment of intractable posterior epistaxis. It is highly effective, but significant complications may occur, including an oroantral fistula and damage to the infraorbital nerve. Embolization is less invasive and can be performed in poor surgical candidates. However, it has more serious complications, such as facial nerve paralysis and hemiplegia. This investigation evaluates the effectiveness and complications of endoscopic ligation of the sphenopalatine or maxillary artery for the treatment of intractable posterior epistaxis.
  
  
  METHODS
  Between April 2003 and March 2007, 46 patients were hospitalized for the treatment of severe posterior epistaxis in our University Hospital. Thirty patients were successfully treated by anterior and/or posterior nasal packing, and five patients were treated by electrocoagulation. Endoscopic ligation was performed under general anesthesia in 11 patients (6 men and 5 women; age range, 50-80 years).
  
  
  RESULTS
  Eight patients underwent endoscopic ligation of the sphenopalatine artery, and three patients underwent endoscopic ligation of the maxillary artery through the middle meatus and posterior antral wall opening. There were no complications, and the patients' postoperative courses were uneventful. Recurrent epistaxis occurred in one patient on oral anticoagulants 15 months after ligation of the sphenopalatine artery, and it was successfully treated by anterior nasal packing.
  
  
  CONCLUSIONS
  Endoscopic ligation of the sphenopalatine or maxillary artery is safer than arterial embolization and is less invasive than transantral ligation of the maxillary artery. This technique appears to be a simple and highly effective surgical treatment for patients with intractable posterior epistaxis.
authors.affiliation: Department of Otorhinolaryngology, Shiga University of Medical Science, Otsu, Shiga, Japan. senosato@belle.shiga-med.ac.jp
authors.forename: Satoshi
authors.initials: S
authors.lastname: Seno
authors.forename: Masahiko
authors.initials: M
authors.lastname: Arikata
authors.forename: Hironori
authors.initials: H
authors.lastname: Sakurai
authors.forename: Shigehiro
authors.initials: S
authors.lastname: Owaki
authors.forename: Jun
authors.initials: J
authors.lastname: Fukui
authors.forename: Mikio
authors.initials: M
authors.lastname: Suzuki
authors.forename: Takeshi
authors.initials: T
authors.lastname: Shimizu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004621:Embolization, Therapeutic; D004724:Endoscopy; D004844:Epistaxis / Q000628:therapy*; D005260:Female; D006801:Humans; D008026:Ligation; D008297:Male; D008438:Maxillary Artery / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D011183:Postoperative Complications; D013101:Sphenoid Sinus / Q000098:blood supply*; D016896:Treatment Outcome