A 45-year-old patient presents with massive posterior epistaxis refractory to anterior and posterior nasal packing. Endoscopic surgery and arterial ligation is planned. Which artery, when ligated, most effectively controls posterior epistaxis from the sphenopalatine territory?
- A Anterior ethmoidal artery
- B Sphenopalatine artery at the sphenopalatine foramen ✓
- C Internal maxillary artery (pterygomaxillary segment)
- D External carotid artery at its origin
Explanation
The sphenopalatine artery, the terminal branch of the internal maxillary artery, supplies the majority of the nasal mucosa and is responsible for most posterior epistaxis. Endoscopic sphenopalatine artery ligation (ESPAL) at the sphenopalatine foramen (identified at the posterior end of the middle turbinate attachment) achieves approximately 95% success in controlling intractable posterior epistaxis. It is safer and equally effective as internal maxillary artery ligation via a Caldwell-Luc approach. Anterior ethmoidal ligation is reserved for anterior or superior epistaxis not controlled by sphenopalatine ligation.
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.