Endoscopic Sphenopalatine Artery Ligation — Active Bleeding

Indications:

• Control of epistaxis
• Vascular control prior to tumor removal

Highlights:

• Incision is made over the palatine bone just posterior to maxillary fontanelle.
• Crista ethmoidalis serves as a landmark just anterior to sphenopalatine foramen.
• Endoscopic clip appliers facilitate clip application.

Keep in Mind/Things to Remember:

• SPA may branch prior to exiting foramen, often with larger SPA branch and smaller posterior nasal branch.
• Isolation of artery from surrounding fascia facilitates clip application and/or cauterization.