Endoscopic clipping of the sphenopalatine artery

Abstract

Different sources of trauma or pathological conditions of the nose may lesion the sphenopalatine artery and cause profuse posterior nasal bleeding. Posterior epistaxis is also common after endonasal surgical procedures. The traditional transmaxillary surgical technique to control this type of bleeding in patients that are seriously ill, anticoagulated or with severe facial trauma is difficult and may be especially hard, particularly in those with grave trauma that involves the maxillary sinus and subsequent collapse of its walls. When there is a fracture of the orbital floor with severe hernia of orbital contents into the maxillary sinus, the last thing one wants to do is cause greater morbidity in an already debilitated patient (Fig. 1). The dilemma arises in these patients when attempting a transmaxillary approach that causes greater damage to the face and removes the walls of a damaged maxillary sinus. In these cases the clipping is very complicated and an endonasal approach with microsurgery or endonasal techniques are a great help in order to resolve the bleeding and can be valuable alternate techniques.