In massive posterior epistaxis that fails to respond to posterior nasal packing, endoscopic sphenopalatine artery ligation (ESPAL) is increasingly preferred over external carotid artery ligation. Which branch of the sphenopalatine artery is most commonly the source of posterior epistaxis?

• A Posterior lateral nasal artery to the inferior turbinate
• B Greater palatine artery from the pterygopalatine fossa
• C Posterior septal artery (nasopalatine artery) running along the nasal septum ✓
• D Anterior ethmoidal artery at the skull base

Explanation

The posterior septal artery (nasopalatine artery) is a branch of the sphenopalatine artery that courses anteriorly along the nasal septum to anastomose with the anterior ethmoidal artery at Little's area (Kiesselbach's plexus). Posterior epistaxis most commonly arises from the septal branch of the sphenopalatine artery near the posterior septum. ESPAL at the sphenopalatine foramen (just posterior to the posterior fontanelle of the middle meatus) controls both the lateral nasal and posterior septal branches. The anterior ethmoidal artery (from the ophthalmic artery) is a separate supply ligated via an external ethmoidectomy approach when needed.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.