Anterior Ethmoid Artery Ligation for Epistaxis: A Systematic Review

For intractable epistaxis unresponsive to conservative measures, surgical intervention, such as anterior ethmoid artery ligation (AEAL), can control bleeding in the superior nasal cavity. Yet, the literature is limited around AEAL for epistaxis control. This systematic review aims to identify the outcomes and complications of the various AEAL approaches.

MEDLINE and PubMed were searched for English-language articles published in peer-reviewed journals using "Epistaxis" AND "anterior ethmoid artery" along with associated terms. Inclusion criteria captured full-text studies that examined AEAL in human subjects as the main treatment, or as part of a combination of treatments. Of the 160 articles reviewed, 21 (13%) met selection criteria. Data were extracted and descriptive statistics were calculated following PRISMA guidelines.

A total of 122 patients underwent various AEAL approaches: external approach via a Lynch incision (76.2%), transnasal endoscopic approach (9.8%), and transcaruncular approach (13.9%). 7/108 patients had postoperative bleeding despite AEAL. 28/99 (28.3%) of patients were reported to have postoperative complications of varying severity. The following complications occurred after an external approach via Lynch incision: eyelid/orbital edema, ptosis, intracerebral abscess, diplopia, dilated pupil, ophthalmoplegia, trigeminal nerve irritation, keratoconjunctivitis, and orbital apex syndrome.

AEAL effectively reduces epistaxis in suitable patients, with most complications from the Lynch incision being temporary. Further research is required to optimize AEAL's approach and utility for intractable epistaxis.