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Related Concept Videos

Epistaxis01:30

Epistaxis

Epistaxis, or nosebleeds, occurs when small, swollen blood vessels in the nasal mucous membrane rupture. Typically, the anterior septum is the primary site of occurrence.
Etiology
Possible causes of this condition include high blood pressure, trauma, low humidity, upper respiratory tract infections, allergies, foreign bodies, nasal inhalation of corticosteroids or illicit drugs, excessive use of decongestant nasal sprays, facial or nasal surgery, anatomic malformation, tumors, or systemic...

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Endoscopic Septoplasty with Limited Two-line Resection: Minimally Invasive Surgery for Septal Deviation
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Modified Endoscopic Sphenopalatine Artery Ligation Technique Reduces Persistent Epistaxis.

Abdulghafoor Alani1, Emma J Anisman1, Benjamin F Bitner1

  • 1Department of Otolaryngology Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.

The Laryngoscope
|June 1, 2026
PubMed
Summary
This summary is machine-generated.

A modified endoscopic sphenopalatine artery ligation (ESPAL) technique, including posterior septal artery (PSA) cautery, significantly reduces persistent epistaxis compared to traditional ESPAL. This improved outcome was observed even in patients using anticoagulation.

Keywords:
endoscopic ligationepistaxisposterior septal arteryrebleedingsphenopalatine artery

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Area of Science:

  • Otolaryngology
  • Minimally Invasive Surgery
  • Vascular Surgery

Background:

  • Refractory posterior epistaxis often requires endoscopic sphenopalatine artery ligation (ESPAL).
  • Traditional ESPAL has limitations, with common persistent bleeding and reintervention needs.
  • A modified ESPAL technique incorporating posterior septal artery (PSA) cautery was developed to improve outcomes.

Purpose of the Study:

  • To evaluate the efficacy of a modified ESPAL technique (including PSA cautery) versus traditional ESPAL.
  • To assess the impact of the modified technique on persistent epistaxis and the need for major intervention.
  • To identify predictors of persistent epistaxis, including surgical technique and patient factors.

Main Methods:

  • Retrospective cohort study of 292 adult patients with posterior epistaxis treated with ESPAL.
  • Comparison between modified ESPAL (n=257) with PSA cautery and traditional ESPAL (n=35).
  • Primary outcome: persistent epistaxis within 30 days requiring major intervention; secondary outcomes: salvage strategies and rebleeding rates.

Main Results:

  • Persistent epistaxis was significantly lower with modified ESPAL (7.8%) versus traditional ESPAL (28.6%).
  • Modified ESPAL demonstrated a 20.8% absolute risk reduction and an NNT of 4.8.
  • Traditional ESPAL (OR: 6.50) and anticoagulation use (OR: 3.22) were independently associated with higher odds of persistent epistaxis.

Conclusions:

  • Modified ESPAL incorporating PSA cautery offers a substantial reduction in 30-day persistent epistaxis.
  • The modified technique is effective even in patients requiring anticoagulation.
  • Bilateral procedures in modified ESPAL appear safe when the bleeding source is uncertain.