Question

A 35 year old male presented with epistaxis . Conservative management was done to stop the bleeding which failed . What is the next step of management?

• A. Endoscopic Sphenopalantine artery lligation
• B. ICA ligation
• C. ECA ligation
• D. Maxillary artery ligation

Answer 1

The Correct Option is A

A 35-year-old male presents with epistaxis (nosebleed), and after conservative management attempts to stop the bleeding were unsuccessful, the next step in management is required.

1. Understanding the vascular supply to the nasal cavity is crucial. The majority of the blood supply to the nasal cavity comes from branches of the external carotid artery (ECA) and the internal carotid artery (ICA).
2. Main contributors to epistaxis include the sphenopalatine artery, ethmoidal arteries, and branches from the facial artery.
3. When conservative measures, such as nasal packing and local pressure, fail to control a nosebleed, surgical intervention is considered.
4. The next appropriate intervention is to target the artery most commonly responsible for posterior epistaxis, which is the sphenopalatine artery, a branch of the maxillary artery (itself a branch of the ECA).
5. Thus, the appropriate surgical intervention is endoscopic sphenopalatine artery ligation, which targets the source directly and is minimally invasive.

This option is preferred because:

• It directly addresses the most common source of severe epistaxis with a high success rate.
• It is less invasive compared to more radical procedures such as ICA or ECA ligation.

Therefore, Endoscopic Sphenopalantine artery ligation is the next step of management in this scenario.