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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