[Our attitude toward so-called essential severe epistaxis. The problem of vascular ligatures]

The authors describe their therapeutic attitude over the past few years towards severe epistaxis. In an emergency, anterior and posterior tamponage using thick tents is the main treatment used. Double balloon probes have been discontinued, in spite of the fact that they were well-tolerated, on account of the disappointing results they gave. In cases of relapse, when the posterior tampon is removed after 48 hours, systematic ligature of the sphenopalatine artery is carried out on arteriosclerosis patients aged about fifty who have high blood pressure. In other cases, the authors wait to see the effect of leaving a second tampon in place for a further 48 hours. In patients suffering from renal inadequacy, reabsorbable tents are preferable, prevention being the main aim, avoiding all treatment liable to counteract haemostasis. Generally speaking, ligature of the external carotid is often ineffective. It is the sphenopalatine artery which should be tied off (100 cases in the O.-R.L. Dept. of the Hôpital Foch). Ligature of the ethmoid is rarely indicated.