title: Resection of the ethmoidal crest in sphenopalatine artery surgery.
abstract: In severe cases of epistaxis, in spite of several procedures described in the literature for its management, surgical treatment has been recognized by most authors as 1 of the most effective, especially when it includes ligation and/or electrocoagulation of the nasal branches of the sphenopalatine artery. The objective of this study is to determine the importance of ethmoid crest resection during sphenopalatine artery surgery, in the management of severe epistaxis.
  
  
  
  We report a double-blinded randomized clinical trial, in which intervention was the ethmoid crest resection during electrocoagulation of the sphenopalatine artery. The study participants consisted of 42 patients with severe epistaxis and indication for surgical treatment, treated at the Otorhinolaryngology Emergency Room (ORL ER) of Hospital Sao Paulo, the teaching hospital of the Federal University of Sao Paulo.
  
  
  
  There was significant greater exposure of the arterial branch after removal of the ethmoidal crest (p = 0.009). The rate of bleeding within 48 hours of the procedure was significantly lower in the crest removal group.
  
  
  
  Resection of the ethmoid crest during sphenopalatine surgery proved to be feasible without additional risks, including promoting decrease in the overall surgical time. It provided better exposure of arterial branches of the sphenopalatine foramen, leading to a lower rebleeding rate within 48 hours.
authors: Department of Otorhinolaryngology and Head and Neck Surgery, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil.
authors: Paulo
authors: P
authors: Saraceni Neto
authors: Department of Otorhinolaryngology and Head and Neck Surgery, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil.
authors: Leonardo Mendes Acatauassu
authors: LM
authors: Nunes
authors: Department of Otorhinolaryngology and Head and Neck Surgery, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil.
authors: Fabio de Azevedo
authors: FA
authors: Caparroz
authors: Department of Otorhinolaryngology and Head and Neck Surgery, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil.
authors: Luciano Lobato
authors: LL
authors: Gregorio
authors: Department of Otorhinolaryngology and Head and Neck Surgery, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil.
authors: Rafael de Paula E Silva Felice
authors: RP
authors: de Souza
authors: Department of Otorhinolaryngology and Head and Neck Surgery, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil.
authors: Juliana Caminha
authors: JC
authors: Simões
authors: Department of Otorhinolaryngology and Head and Neck Surgery, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil.
authors: Eduardo Macoto
authors: EM
authors: Kosugi
mesh_terms: D000328:Adult; D000368:Aged; D001158:Arteries / Q000601:surgery*; D004311:Double-Blind Method; D004564:Electrocoagulation; D004844:Epistaxis / Q000601:surgery*; D005005:Ethmoid Sinus / Q000098:blood supply / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged
keywords: endonasal surgery; epistaxis; ethmoidal crest; nasal surgical procedures; sphenopalatine artery