Surgical Management of Severe Epistaxis

Otolaryngol Clin North Am. 2016 Jun;49(3):627-37. doi: 10.1016/j.otc.2016.01.003.


Many patients with severe epistaxis benefit from endoscopic intervention for control of bleeding. Critical maneuvers to improve endoscopic visualization during surgery include head-of-bed elevation, application of topical vasoconstrictors, and local injection of vasonstrictors. Controlled, hypotensive anesthesia may also decrease intraoperative blood loss and improve visualization during surgery. Intractable posterior epistaxis can be controlled with high rates of success with endoscopic sphenopalatine artery ligation. Although less common, intractable anterior epistaxis may be controlled by anterior ethmoid artery ligation once this artery is identified as the primary source. Less common sources of severe epistaxis are also discussed in this article.

Keywords: Anterior ethmoid artery ligation; Endoscopic sinus surgery; Epistaxis; Hemostasis; Sphenopalatine artery ligation.

Publication types

  • Review

MeSH terms

  • Blood Loss, Surgical / prevention & control*
  • Endoscopy* / adverse effects
  • Endoscopy* / methods
  • Epistaxis / surgery*
  • Hemostasis, Surgical / methods*
  • Hemostatic Techniques*
  • Hemostatics / pharmacology*
  • Humans
  • Outcome and Process Assessment, Health Care
  • Severity of Illness Index


  • Hemostatics