In the management of acute massive epistaxis unresponsive to anterior and posterior nasal packing, the next intervention in an elderly hypertensive patient is:

• A External carotid artery ligation
• B Interventional radiological embolization of internal maxillary artery
• C Repeat posterior nasal packing with a Foley catheter
• D Sphenopalatine artery ligation via endonasal endoscopic approach ✓

Explanation

Endoscopic sphenopalatine artery (SPA) ligation is now the preferred surgical intervention for refractory posterior epistaxis because it directly targets the terminal branch supplying the posterior nasal septum and lateral wall (the Kiesselbach's/Woodruff's area blood supply). Compared to external carotid ligation, it is more targeted and has lower complication rates. Embolization is an alternative but carries risk of cerebral embolism. Repeat packing is not an escalation. SPA ligation under endoscopy has become the gold standard over open approaches.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.