Ligation of Vessels


(a) External carotid. When bleeding is from the externalcarotid system and the conservative measures havefailed, ligation of external carotid artery above the originof superior thyroid artery should be done. It is avoidedthese days in favour of embolisation or ligation of moreperipheral branches.

(b) Maxillary artery. Ligation of this artery is done inuncontrollable posterior epistaxis. Approach is viaCaldwell- Luc operation. Posterior wall of maxillary•sinus is removed and the maxillary artery or its branchesare blocked by applying clips.
Endoscopic ligation of the maxillary artery can also be done through nose.

(c) Ethmoidal arteries. In anterosuperior bleeding abovethe middle turbinate, not controlled by packing, anteriorand posterior ethmoidal arteries which supply this area,can be ligated. The ''essels are exposed in the medialwall of the orbit by an external ethmoid incision.

General Measures in Epistaxis

1. Make the patient sit up with a back rest and record any blood loss taking place through spitting or vomiting.


2. Reassure the patient. Mild sedation should be given.

3. Keep check on pulse, blood preasure and respiration.

4. Maintain haemodynamics. Blood transfusion may berequired.

5. Antibiotics may be given to prevent sinusitis, if pack isto be kept beyond 24 hours.

6. Intermittent oxygen may be required in patients withbilateral packs because of increased pulmonaryresistance from nasopulmonary reflex.

7. Investigate and treat the patient for any underlying localor general cause.
Hereditary haemorrhagic telangectasia: It occurs on the anterior part of nasal septum and is the cause of recurrent bleeding. It can be treated by using Argon, KTP or Nd: YAG laser. The procedure may require to be repeated several times in a year as telangectasia recurs in the surrounding mucosa. Some cases require septodermoplasty where anterior part of septal mucosa is excised and replaced by a split skin graft.



chronic-sinusitis