Endoscopic monopolar cauterization of the sphenopalatine artery: a single surgeon’s experience

BACKGROUND: Epistaxis is one of the most common otolaryngology emergency conditions, and is usually treated conservatively by different types of nasal packs. A limited number of patients continue to bleed even with tightly fitted anterior and posterior packs in the nose. Such intractable epistaxis is managed by surgery or embolization. OBJECTIVES: We reviewed the use and outcomes of endoscopic suction monopolar cauterization of the sphenopalatine artery. DESIGN: Retrospective study. SETTING: Tertiary academic center. PATIENTS AND METHODS: Subjects who underwent consecutive monopolar sphenopalatine artery ligation for intractable epistaxis performed by a senior author from August 2010 to December 2014. MAIN OUTCOME MEASURE(S): Successful management of refractory epistaxis. RESULTS: In 15 subjects (mean age 45 years; 10 men and 5 women) idiopathic epistaxis was the most common indication for surgery. Six patients had hypertension and three were on anticoagulation. One patient required bilateral cauterization and another had anterior ethmoid artery cauterization. The average operative time was 57 minutes. There was no major intra- or postoperative complications. Two patients underwent endoscopic sinus surgery to treat pathologies that were found during the procedure. All patients had healthy nasal and sinus mucosa during the follow-up period (average 17 months, range 1–70 months), and none suffered recurrent epistaxis. CONCLUSIONS: Endoscopic monopolar cauterization of sphenopalatine artery is safe and effective for management of refractory epistaxis with minimal complications. It should be considered earlier in the algorithmic treatment of intractable epistaxis. LIMITATIONS: Retrospective study, small number of patients, and no controls.