Resection of the ethmoidal crest in sphenopalatine artery surgery

• Published in: International forum of allergy & rhinology 2017-01, Vol.7 (1), p.87-90
• Main Authors: Saraceni Neto, Paulo, Nunes, Leonardo Mendes Acatauassu, Caparroz, Fabio de Azevedo, Gregorio, Luciano Lobato, Souza, Rafael de Paula e Silva Felice, Simões, Juliana Caminha, Kosugi, Eduardo Macoto
• Format: Article
• Language: English
• Subjects: Adult; Aged; Arteries - surgery; Double-Blind Method; Electrocoagulation; endonasal surgery; epistaxis; Epistaxis - surgery; Ethmoid Sinus - blood supply; Ethmoid Sinus - surgery; ethmoidal crest; Female; Humans; Male; Middle Aged; nasal surgical procedures; Otolaryngology; sphenopalatine artery; Surgery; Veins & arteries
• ISSN: 2042-6976; 2042-6984
• DOI: 10.1002/alr.21832

Background In severe cases of epistaxis, in spite of several procedures described in the literature for its management, surgical treatment has been recognized by most authors as 1 of the most effective, especially when it includes ligation and/or electrocoagulation of the nasal branches of the sphenopalatine artery. The objective of this study is to determine the importance of ethmoid crest resection during sphenopalatine artery surgery, in the management of severe epistaxis. Methods We report a double‐blinded randomized clinical trial, in which intervention was the ethmoid crest resection during electrocoagulation of the sphenopalatine artery. The study participants consisted of 42 patients with severe epistaxis and indication for surgical treatment, treated at the Otorhinolaryngology Emergency Room (ORL ER) of Hospital Sao Paulo, the teaching hospital of the Federal University of Sao Paulo. Results There was significant greater exposure of the arterial branch after removal of the ethmoidal crest (p = 0.009). The rate of bleeding within 48 hours of the procedure was significantly lower in the crest removal group. Conclusion Resection of the ethmoid crest during sphenopalatine surgery proved to be feasible without additional risks, including promoting decrease in the overall surgical time. It provided better exposure of arterial branches of the sphenopalatine foramen, leading to a lower rebleeding rate within 48 hours.