Endoscopic transseptal sphenopalatine artery ligation for intractable posterior epistaxis

The rigid nasal endoscope was used through a transseptal approach to reach the sphenopalatine foramen and to ligate its artery in 9 patients with intr actable posterior epistaxis. Immediate and complete cessation of the bleedi ng uniformly occurred, except in 1 case, in which there was persistent blee ding on endoscopic examination of the nasal cavity at the end of the proced ure. The ligature was checked and the artery was reclipped. Thereafter, the patient's recovery was uncomplicated and free of further epistaxis. Endosc opic transseptal sphenopalatine artery ligation offers a reliable option in the treatment of intractable posterior epistaxis. The submucoperiosteal di ssection reduces bleeding, shortens operation time, and allows relatively e asy identification of the sphenopalatine foramen. The procedure allows dire ct positive control of the major vessel supplying the posterior nasal cavit y. It avoids the complications associated with transantral and pterygopalat ine fossa surgery.