Search Results (4)

Objectives: Epistaxis is a common condition affecting up to 60% of the population, with approximately 6% requiring medical intervention. Posterior epistaxis is particularly challenging, often necessitating endoscopic or endovascular treatment. Sphenopalatine artery (SPA) embolization is an effective treatment option, though concerns remain about the risks associated with nonselective or bilateral approaches. This study evaluates the efficacy and safety of unilateral superselective SPA embolization in managing severe posterior epistaxis. Methods: A prospective study of patients undergoing unilateral superselective SPA embolization for refractory posterior epistaxis over a four-year period was conducted. Demographic data, clinical history, prior treatments, and procedural characteristics were analyzed. The primary endpoint was clinical success, defined as the absence of recurrent bleeding within 24 h post-procedure. Secondary outcomes included recurrence at one month and complication rates. Results: Thirty-two patients with severe posterior epistaxis were included. All required nasal packing prior to embolization. Half had undergone previous endoscopic cauterization. Hypertension was present in 69%, and 56% were receiving anticoagulant or antiplatelet therapy. Clinical success was achieved in 100% of cases, with no rebleeding in the first 24 h. Two patients (6%) experienced early recurrence within seven days, requiring readmission. Minor complications included nasal dryness in two cases (6%); no major complications occurred. Mean fluoroscopy time was 19.9 ± 11 min. Conclusions: Unilateral superselective SPA embolization is a safe and highly effective treatment for severe posterior epistaxis, offering high initial success and low complication rates. Its adoption may reduce the need for bilateral procedures and surgical interventions. Full article

Background and Objectives: Endoscopic sphenopalatine artery cauterization (ESPAC) has become a reliable and effective surgical procedure for managing posterior epistaxis. The objectives of our study were to evaluate the effectiveness of ESPAC in the management of posterior epistaxis and the possible factors that lead to the failure of the procedure. Materials and Methods: We performed a retrospective analysis of all patients who underwent ESPAC between 2018 and 2022. We retrospectively reviewed the demographic data, patients’ co-morbidities, medical treatment conditions, whether other surgical procedures were performed in addition to the ESPAC, and the success rate of ESPAC. Results: 28 patients were included in our study. After ESPAC, epistaxis was successfully managed in 25 patients (89.28%). Of all patients undergoing ESPAC, three (10.7%) presented re-bleeding. In two patients, we performed an endoscopic revision surgery with re-cauterization of the sphenopalatine foramen area, together with anterior and posterior ethmoidectomy, followed by fat occlusion/obliteration of these sinuses. In one patient, fat obliteration of the anterior and posterior ethmoid was also unsuccessful, and we performed an external carotid artery ligation at the level of the neck with no recurrence afterwards. Conclusions: Endoscopic cauterization of the sphenopalatine artery remains a safe, effective, and reliable surgical procedure in the management of recurrent posterior epistaxis. The use of anticoagulant drugs and the association of hypertension and other heart and liver diseases do not materialize as factors influencing surgical failure. Full article

Angiofibroma is a relatively rare vascular lesion originating predominantly in the nasopharynx and occurs typically in male adolescents. Extranasopharyngeal sites of origin, such as nasal cavity, paranasal sinuses, pharynx, and larynx, are extremely rarely seen in clinical practice. In the nasal cavity, extranasopharyngeal angiofibromas (ENAs) have been reported to originate from the nasal septum, as well as from the middle and inferior turbinate. In this study, we report a case of a 35-year-old female patient with angiofibroma originating from the anterior part of the nasal septum with left-sided nasal obstruction and mild-to-moderate epistaxis as main complaints. After the radiological diagnostics and embolization of sphenopalatine artery, we performed the excision of the lesion with removal of small part of septal mucosa and perichondrium around the attachment of tumor pedicle. Histopathological examination suggested the presence of angiofibroma and diagnosis was confirmed by immunohistochemical analysis. This is the fifth reported case of septal ENA in female population in the English-language literature. Full article

Pedicle flaps based on the external maxillary (facial) artery were introduced during the World War I, precisely a century ago. Today they remain effective tools in facial soft-tissue repair. Recently, pedicle flaps based on the internal maxillary (sphenopalatine) artery have been chosen to reliably close dural defects after endoscopic skull-base surgery. Pedicle flaps, “biologic” to the extent they are based on a defined arterial blood supply, are the lasting contributions—the diuturnity”of Johannes (“Jan”) Fredericus Samuel Esser (1877–1946) of Leiden, Holland, and Chicago (IL). Full article