Trasantral internal maxillary artery ligation for intractable epitaxis.

Abstract

Intractable epitaxis continues to remain a difficult management problem for otolaryngologists.It can be life threatening because of anemia,aspiration, hypovolumic shock and associated comorbidities.
Conventional management options in the form of anterior and posterior nasal packing, known to cause discomfort, airway compromise or hypoxia ,mucosal truama and infection.Moreover,it is frequently ineffective to stop bleeding. Sometime ligation of external carotid was done, but have been associated with a high failure rate. Transantral internal maxillary artery ligation is more effctive than nasal packing and external carotid ligation. Angiography and embolization or endoscopic sphenopalatine artery ligation cannot be done in most general hospital of Thailand due to insufficiency of instrument such as endoscope and experience of surgions. Also transantral internal maxillary artery ligations is a simplified and not require more instruments. It is necessary and usefull procedure for Thai otolaryngologists. Our drescriptive study show six refractory epitaxis patients who were received successful transantral internal maxillary artery ligation and good outcome.