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Abstract
Epistaxis is the commonest emergency in otorhinolaryngology ,epistaxes are usefully classified as either anterior or posterior, Between 90 and 95% of epistaxes are anterior, and the great majority of these arise from Little’s area. Posterior bleeding derives primarily from the posterior septal nasal artery (a branch of the sphenopalatine artery), which forms part of the Woodruff plexus. In the patient presenting with active posterior epistaxis, the initial priority is to achieve control of the bleeding. This can usually be achieved rapidly by packing the nose choosing the side from which the bleeding started if on presentation there is bleeding from both nostrils. The patient should be stabilized and other contributing factors such as coagulopathy and hypertension identified and addressed. The lateral origin of the bleeding suggests that bilateral packing is seldom justified. Traditionally, packing was performed with ribbon gauze, usually coated with antibiotic ointment or bismuth iodoform paraffin paste,.Surgery for intractable epistaxis has been indicated mainly for failure of conservative management. However, surgery has well-documented high success rates and low complication rates in the management of posterior epistaxis.Surgical intervention can be divided into endoscopy with point cauterization, septal surgery, and arterial embolization or ligation.A number of techniques of arterial ligation for posterior epistaxis have been described, including transantral ligation of the sphenopalatine or maxillary artery and tying off the external carotid artery in the neck. Sphenopalatine artery ligation. Microsurgical ligation of the sphenopalatine artery was introduced by Prades in the 1970s.A major advance in the management of posterior epistaxis has been the development of techniques for endoscopic ligation or cautery of the sphenopalatine artery. The approaches to SPA are diverse, including transantral ,transseptal ,transpalatal and transnasal methods with the help of an endoscope, the transnasal approach is easier to locate the sphenopalatine foramen and artery.Most of T.E.S.P.A.L, including the identification and ligation ended within one hour. Endoscopic ligation of the sphenopalatine artery is now emerging as the most effective and cost-efficient definitive treatment for posterior epistaxis .
OBJECTIVES : the aim of the work is to evaluate the different approaches for sphenopalatine artery ligation