[Intranasal microsurgical procedure in epistaxis of the cribriform plate and further interventions using hypotension]

For the past 25 years we have been able to control severe epistaxis in all patients by an intranasal procedure. If the source of bleeding in patients with epistaxis from the upper part of the nose cannot be seen during the acute phase, a combined anterior-posterior nasal pack is inserted and left in place for three days. Should bleeding persist or recur after removal of the packing we resect the superior nasal septum to expose the bleeding point in the anterior area of the cribriform plate. Cauterization at this site is not safe because of the risk of CSF rhinorrhea, and it is not always successful, as the main blood supply to the ethmoidal arteries stems from the internal carotid artery. Cauterization of the anterior or posterior ethmoidal arteries within the bony canal of the ethmoidal sinus (after partial ethmoidectomy) is always successful. Ligation or embolization of the carotid arteries is indicated only for tumour patients. Intranasal ethmoidal microsurgery requires much practice and preliminary experience on at least 50 cadavers. In 25 years with an annual load of about 180 ethmoidal sinus surgery cases we have never had serious complications such as cerebrospinal fluid rhinorrhea or persisting optical disturbances in more than 4,000 operations. During 1984 at the Krupp Hospital we used the intranasal microsurgical approach for all patients with septal, ethmoidal sinus and lacrimal duct pathology, for 98% of cases requiring maxillary sinus procedures and for 82% of patients with frontal sinus problems.(ABSTRACT TRUNCATED AT 250 WORDS)