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Endoscopic sphenopalatine artery ligation for acute idiopathic epistaxis. Do anatomical variation and a limited evidence base raise questions regarding its place in management?

Published online by Cambridge University Press:  09 February 2017

A Ellinas ,
P Jervis ,
G Kenyon  and
L M Flood
A Ellinas
Affiliation:
ENT Department, Northampton General Hospital, UK
P Jervis
Affiliation:
ENT Department, Northampton General Hospital, UK
G Kenyon
Affiliation:
Department of Physiology, Development and Neuroscience, University of Cambridge, UK
L M Flood*
Affiliation:
ENT Department, James Cook University Hospital, Middlesbrough, UK
*
Address for correspondence: Mr Liam M Flood, ENT Department, James Cook University Hospital, Marton Rd, Middlesbrough TS4 3BW, UK E-mail: Liam.flood@nhs.net
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Abstract

Background:

Endoscopic sphenopalatine artery ligation is widely accepted as effective and safe for acute spontaneous epistaxis that is unresponsive to conservative management. As with many new procedures, it has been progressively adopted as common practice, despite a limited evidence base for its efficacy. Early reviews called for comparative trials to support its adoption, but subsequent literature largely consists of case series and narrative reviews. These have attempted to derive an algorithm to establish its place in management, but consensus is still lacking. Intuitively, although there are theoretical objections, an operation regarded as relatively simple, fast and safe hardly seems to demand high-level evidence of efficacy. Rhinologists may be influenced by years of personal experience and success with the technique. However, estimates of the effect size and the added contribution to traditional surgical management are lacking. If the procedure could be shown to dramatically influence outcome, it should be standard practice and indispensable for all patients requiring operative intervention.

Objectives:

This paper systematically examined the literature, appraising the anatomical basis for such an approach and evidence for its efficacy. It questions whether any units unable to consistently offer endoscopic sphenopalatine artery ligation should be undertaking surgical management of acute epistaxis.

Keywords

EpistaxisEndoscopySurgeryLigation
Type
Review Articles
Information
The Journal of Laryngology & Otology , Volume 131 , Issue 4 , April 2017 , pp. 290 - 297
Copyright
Copyright © JLO (1984) Limited 2017 

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