Internal maxillary artery ligation for epistaxis: An analysis of failures

Abstract

The records of 100 consecutive patients undergoing transantral ligation of the internal maxillary artery (IMA) for epistaxis, including 15 patients who developed postoperative bleeding, were reviewed. Preoperative parameters predictive of surgical failure were advanced age, anemia, and a history of hypertension. The causes of postoperative epistaxis, as determined by surgical reexploration or angiography in 12 cases, included failure to identify the IMA in the pterygomaxillary space (6 cases), blood flow through partially closed clips on the IMA (2 cases), bleeding from posterior ethmoid arteries (2 cases), and revascularization of the nasal blood supply (2 cases). The incidence of surgical failure may be reduced by proper techniques of IMA identification and ligation.

Endoscopic Management of Posterior Epistaxis

“…This included 14 males and 9 females. The age wise distribution of the patients was: less than 20 years (2), 21-40 years (7), 41-60 years (8) and above 60 years (6). In four (17%) patients, unsuspected diagnosis was made on nasal endoscopy.…”

“…It is usually performed through the transantral route under general anesthesia. Reported success rates range from 75 to 100% [8,9].…”

Surgical management of intractable epistaxis: audit of results

“…Inability to identify the internal maxillary artery branches in the pterygopalatine fossa is one of the important reasons as there can be considerable variability of the distal arterial branches. 10,14 Other reasons include extensive anastomosis of blood vessels distal to the point of ligation and dominance of one maxillary artery. 15,16 The external carotid system provides blood supply to most of the nasal cavity through the maxillary artery, and the internal carotid system (through the anterior ethmoid artery) supplies a small area in the roof and adjacent parts of the septum and lateral wall.…”

Die perkutane Embolisationstherapie bei therapierefraktärer, nicht-traumatischer Epistaxis

“…So wird die Ligatur der A. maxillaris auch heute noch vielerorts als Methode der 1. Darüber hinaus ist auch die Unterbindung der A. maxillaris nicht immer erfolgreich; Metson und Lane [15] berichten über Rezidivblutungen von ca. Doch ist auch die transmaxilläre Ligatur der A.maxillaris in der Fossa pterygopalatina ein mit gewissen Risiken und Nebenwirkungen [1] behafteter Eingriff.…”