Sphenopalatine Artery Control Sphenopalatine Artery Control Instructional Course Instructional Course Mr Maged Abdelkader Mr Maged Abdelkader MSc MD FRCS(Edin.,Glas.,Irel.) FRCS(ORL MSc MD FRCS(Edin.,Glas.,Irel.) FRCS(ORL - - HNS)Edin HNS)Edin Consultant ENT Head&Neck surgeon Consultant ENT Head&Neck surgeon Basildon &Thurrock University Hospitals Basildon &Thurrock University Hospitals Associate Teaching Hospitals, University Associate Teaching Hospitals, University College London College London UK UK Topics Topics Introduction Introduction Anatomy Anatomy Indications Indications Instruments Instruments Technique and pitfalls Technique and pitfalls Results Results Conclusions Conclusions
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Sphenopalatine Artery Control Instructional Course - … Course ... – Sphenopalatine ... Endoscopic control of the sphenopalatine artery for epistaxis: long-term results. Abdelkader
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Consultant ENT Head&Neck surgeonConsultant ENT Head&Neck surgeonBasildon &Thurrock University HospitalsBasildon &Thurrock University HospitalsAssociate Teaching Hospitals, University Associate Teaching Hospitals, University
College LondonCollege LondonUKUK
TopicsTopics�� IntroductionIntroduction�� AnatomyAnatomy�� IndicationsIndications�� InstrumentsInstruments�� Technique and pitfallsTechnique and pitfalls�� ResultsResults�� ConclusionsConclusions
�� SPA not yet 1SPA not yet 1stst lineline�� Direct therapy is Direct therapy is
bestbest
IntroductionIntroduction
�� Around 20% of nose bleeds are posteriorAround 20% of nose bleeds are posterior(Schaitkin, 1987)(Schaitkin, 1987)
�� Posterior epistaxis poses a challenge. Posterior epistaxis poses a challenge. (O(O’’Flynn and Shadaba, 2000)Flynn and Shadaba, 2000)
�� Failure rates of AP packing varies widely from Failure rates of AP packing varies widely from 0% to 52% (Pollice PA, 1997. Cannon CR, 0% to 52% (Pollice PA, 1997. Cannon CR, 1993)1993)
IntroductionIntroduction
�� Transnasal endoscopic sphenopalatine artery Transnasal endoscopic sphenopalatine artery (SPA) ligation has become a popular (SPA) ligation has become a popular techniquetechnique
�� Published data suggest cessation of epistaxis Published data suggest cessation of epistaxis in 90in 90--100% of patients100% of patients
�� Individual study sample sizes are small, Individual study sample sizes are small, continuing audit of surgical outcome is continuing audit of surgical outcome is required to validate these early results required to validate these early results (Kumar(Kumar et alet al, 2003), 2003)
AnatomyAnatomy
AimAim
�� Review applied anatomy for SPA Review applied anatomy for SPA ligationligation
ConclusionsConclusions�� Both post operative and longBoth post operative and long--term success rates for term success rates for
the procedure are lower than previously published the procedure are lower than previously published datadata
�� Recurrence of epistaxis requiring active intervention Recurrence of epistaxis requiring active intervention occurred within one month of the procedure in all of occurred within one month of the procedure in all of the cases where the procedure failedthe cases where the procedure failed
�� No incidence of failure in the long term found (after No incidence of failure in the long term found (after 12 month)12 month)
ConclusionsConclusions
�� Endoscopic intranasal clipping of the SpA Endoscopic intranasal clipping of the SpA is a reliable procedure in controlling is a reliable procedure in controlling posterior epistaxis but has a consistent posterior epistaxis but has a consistent failure rate ~ 10%failure rate ~ 10%
�� Failures occur within a month of ligationFailures occur within a month of ligation
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Endoscopic control of the sphenopalatine artery for epistaxis: long-term results.Abdelkader M,Leong SC,White PS.
Department of Otolaryngology, University of Dundee, Ninewells Hospital and Medical School, Dundee, Scotland, UK.The aim of this study was to prospectively evaluate post-operative cessation of bleeding and late recurrence of epistaxis in a cohort of patients treated by endoscopic ligation of the sphenopalatine artery. Participants comprised patients undergoing sphenopalatine artery ligation for posterior epistaxis at three east Scotland hospitals. Main outcome measures were recurrence of epistaxis in the immediate post-operative period and at long-term follow up (minimum nine months). Forty-three patients (30 men and 13 women) underwent 45 procedures; two patients underwent bilateral ligation. Two patients suffered recurrence as in-patients. Two patients experienced subsequent epistaxis requiring medical treatment. Two further patients suffered minor late epistaxis not requiring treatment. Success in preventing significant recurrence was 93 per cent. All recurrences requiring intervention occurred within one month of surgery. None of the patients in this series reported nasal complications. We found sphenopalatine artery ligation to be an effective means of achieving long-term control of posterior epistaxis.PMID: 17201991 [PubMed - as supplied by publisher]