Management of severely bleeding ethmoidal arteries

OBJECTIVES: Ethmoidal arteries (EAs) can be responsible for severe bleeding. Clinical features of EA bleeding are rather extensive because it can occur within the nasal cavity or in orbital spaces. Furthermore, surgical management of EA bleeding is challenging. STUDY DESIGN: Retrospective evaluation. METHOD OF STUDY: Five clinical patients with severe bleeding from EAs and/or epistaxis refractory to sphenopalatine artery closure were included in this work. Careful anatomic dissection of the orbitoethmoidal region was performed in 3 fresh injected heads. RESULTS: Ethmoidal artery management is not uniform because it depends on the rapidity and severity of the bleeding and the chambers within which it happens. Trauma-related bleeding usually requires a lateral canthotomy, whereas in intraoperative bleeding, efforts should be made to directly coagulate the bleeding vessel, even within the orbital fat. Spontaneous epistaxis refractory to sphenopalatine artery closure is to be addressed externally, preferably under endoscopic vision. CONCLUSIONS: Ethmoidal artery management differs according to the clinical situation. Elective surgery is advisable for spontaneous epistaxis, whereas emergency treatment, ranging from intraorbital coagulation of the bleeding vessel to lateral canthotomy (when the patient is in a sight-threatening condition), is necessary when the bleeding occurs within orbital spaces. A treatment management algorithm is useful in cases of severe and refractory EA bleeding.