Ligation of the external carotid artery for severe epistaxis.

Epistaxis which is not controlled by anterior and posterior nasal packing is usually treated by ligation or embolization of the arterial supply to the nose. Transantral ligation of the maxillary artery, or embolization of its branches, have recently been considered the treatments of choice. Ligation of the external carotid artery has the advantage of being a short procedure which can be readily performed under local anesthesia, and does not require particular surgical expertise or the use of specialized equipment. This procedure, in combination with ligation of the ipsilateral anterior ethmoidal artery, controlled the bleeding in 14 of 15 patients over a nine-year period. There were no deaths and no significant complications. Although ligation and embolization of the maxillary artery are of proven efficacy, ligation of the external carotid artery is similarly effective and its simplicity may still make it the procedure of choice in some situations.