Endoscopic transnasal transethmoid ligation of the anterior ethmoid artery.

Background: The current otolaryngologic literature is lacking in basic science investigation regarding endoscopic anterior ethmoid artery (AEA) ligation as part of the armamentarium for epistaxis control. This investigation provides the anatomic rationale for endoscopic ligation of the AEA in the surgical treatment of epistaxis. In addition, it provides tools for identification of this vessel during routine endoscopic sinus surgery.

Methods: This descriptive cadaver study investigates the feasibility of endoscopic transnasal transethmoid dissection; anatomic description; and clip ligation within the periorbital space of 16 AEA specimens. A careful assessment for skull base penetration and disruption was performed.

Results: All 16 anterior ethmoid arteries were readily identified and successfully clipped. The anatomy was carefully observed and described for each specimen, and no inadvertent skull base penetration occurred.

Conclusion: This study confirms that endoscopic ligation of the AEA is a safe and feasible technique for the control of epistaxis. Additionally, this anatomic knowledge is beneficial during routine endoscopic sinus surgery if AEA injury should occur. Further evaluation is necessary for clinical application of this technique in the treatment of epistaxis.