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Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Management of severely bleeding ethmoidal arteries
Iacopo Dallan1, Manfred Tschabitscher, Paolo Castelnuovo
1ENT Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy. iacopodallan@tiscali.it
The Journal of Craniofacial Surgery
|March 12, 2009
Summary
Severe bleeding from ethmoidal arteries (EAs) requires tailored management. Treatment varies from external endoscopic approaches for spontaneous epistaxis to intraorbital coagulation or lateral canthotomy for emergency, sight-threatening orbital bleeding.
Area of Science:
- Otorhinolaryngology
- Ophthalmology
- Surgical Anatomy
Background:
- Ethmoidal arteries (EAs) can cause severe nasal and orbital bleeding.
- Management of EA bleeding is complex due to varied clinical presentations and locations.
- Surgical intervention for EA bleeding presents significant challenges.
Observation:
- A retrospective study evaluated five patients with severe EA bleeding or epistaxis unresponsive to sphenopalatine artery closure.
- Anatomical dissections of the orbitoethmoidal region were performed on fresh specimens to understand surgical approaches.
Findings:
- Management strategies for EA bleeding are not standardized, depending on bleeding rate, severity, and anatomical location.
- Trauma-induced bleeding often necessitates lateral canthotomy. Intraoperative bleeding requires direct vessel coagulation, potentially within orbital fat.
- Spontaneous epistaxis refractory to sphenopalatine artery closure benefits from external management, ideally with endoscopic guidance.
Implications:
- Clinical decision-making for EA bleeding must consider the specific presentation, ranging from elective endoscopic surgery for spontaneous epistaxis to emergency intraorbital coagulation or lateral canthotomy for sight-threatening conditions.
- A structured treatment algorithm can aid in managing severe and refractory ethmoidal artery bleeding.
- Understanding the anatomical nuances of the orbitoethmoidal region is critical for effective surgical intervention.
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