Alternative Surgical Techniques

Before the introduction of the endoscope, packing with an anterior and/or posterior balloon or pack, sometimes in conjunction with a submucous resection, was often done. Failing that, maxillary artery ligation has also been advocated, via a Caldwell-Luc ap-

Fig. 14.22 a Peroperative view of a bleeding septal branch of b The septal branch being coagulated with unipolar suction the sphenopalatine artery exposed during a sphenoidotomy. diathermy.

a proach. Other alternatives include embolization. Liga-tion of the external carotid artery is now avoided wherever possible because it limits access for inter-ventional radiology should this be required at a later date and because of the rich cross-circulation from the other side. Ligating the artery that is at a distance from the responsible bleeding point is less effective than ligating the artery near where it is bleeding. The aim should be to minimize risk and morbidity and to deal with the bleeding as near to its site as possible. This normally means doing a sphenopalatine artery liga-tion.

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