Endoscopic Endonasal Greater Palatine Artery Cauterization for Control of Recurrent Anterior Epistaxis
Anna Butrymowicz, MDAssistant ProfessorUniversity of California- San FranciscoDepartment of Otolaryngology
Disclosures
None
https://mashable.com/2014/03/17/grandma-instagram-cancer/3
Introduction
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Outline
Background
Current Techniques
Role for Greater Palatine Artery Ligation
Patient Selection
Anatomy
Surgical Description
5
Background
• Epistaxis Lifetime Prevalence: 60%
• Little’s Area: 80%
• Nosebleeds Seeking Medical Attention: 6%
• Algorithm: Anterior Pressure and Afrin Cautery Packing Surgery
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Current TechniquesIf Conservative Measures Fail
Cautery
Packing
Sphenopalatine Artery Ligation
Anterior Ethmoid Artery Ligation
Angiography
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Rationale for Greater Palatine Artery Cautery
Less Invasive
Easy Recovery
No Sinus Intrusion
Patient Selection is Key
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Blo
od
Su
pply
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SPA
Lig
at
ion
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AEA
Lig
at
ion
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IMA
X
em
bo
liz
at
ion
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Ophthalmic Artery
Anterior FalcineBr of Ethmoidal
A.
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GPA
LIg
at
ion
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Co
lum
ella
V2
Facial Artery
Coronary Artery aka Septal Br. of SLA
Superior Labial Artery
Angular Artery
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Max
illar
y C
rest
Floor of Nose
Sep
talF
lap
Incisive Foramen
Greater Palatine Artery
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Patient Data
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• Predictable location • 2-3 cm from the nasal sill*• <1 cm from anterior nasal spine
• Anticipate Underestimation of distances• Bharadwaj et. al (1986): Injection of GPA• SPA in conjunction?• Caution Nasopalatine Nerve• Risks: Septal Perforation, recurrent bleed
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Proposed Algorithm
Pressure/ Spray
Pressure/ Spray CauteryCautery Nasal PackingNasal Packing
EndonasalGreater
Palatine Artery Cautery
SPA LigationSPA Ligation EmbolizationEmbolization
“Questions?
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