الفهرس 
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Abstract
The lifetime incidence of epistaxis is about 60% and it is the most common emergency otolaryngologists’ encounter. It shows bimodal progress according to the age range. It peaks before the age of ten and between 45 and 65 years of age. The estimated incidence is 1/1000 population per year.
In addition to digital trauma, nasal septum deviation, neoplasms and chemical irritants, systemic factors such as coagulopathies, kidney failure, alcoholism, and vascular anomalies can also be causes. Seasonal changes, allergic rhinitis, exogenous or endogenous estrogens, environmental humidity, and upper respiratory tract infections increase its incidence.
Epistaxis can be life- threatening due to aspiration, hypotension, and anemia as well as associated co-morbidities. Five-to-fifteen percent of patients requiring hospital admission for this condition will need some form of surgical intervention.
Up to 90% of epistaxis cases have their origin in the Kiesselbach area and are managed with chemical cautery or packing, but 10% of cases originate from the posterior nasal area and require more aggressive blockage or other interventions. Posterior nasal packing, including balloon tamponade, has a high failure rate, ranging from 26% to 52%.
Intractable epistaxis remains a challenge for otolaryngologists. Historically, internal maxillary artery ligation via a transantral approach and ligation of the ethmoidal vessels and the external carotid artery have been the treatment of choice when conservative management failed.
In the cases of conservative management failure, ligation of the major arteries or percutaneous embolization of the maxillary artery is performed routinely in most units, but rates of failure and complications are high. Over the past decade, with the widespread popularization of endoscopic sinus surgery and the deeper understanding of local regional anatomy, endoscopic control of the sphenopalatine artery (SPA) has been advocated as an effective alternative for the control of posterior epistaxis.
The aim of the work was to evaluate the effectiveness of endoscopic sphenopalatine artery cauterization for the treatment of posterior epistaxis. The current study included 20 patients with severe posterior epistaxis.
The current study included 20 patients with severe posterior epistaxis. They all presented to the emergency and outpatient ENT clinics at Minia University hospital. Their age ranged from 12 to 70 years.
The results revealed that:
1. The mean age of the study patients was 27.25 years, with standard deviation 27.25. their ages ranged from 12 to 70 years.
2. Seven were males (35%) and thirteen were females (65%).
3. Six patients had bilateral epistaxis (30%), nine patients had right-sided epistaxis (45%), five patients had left-sided epistaxis (25%).
4. Two patients had history of trauma (10%), one patient had a history of nasal operation 3 years ago (5%), and seventeen patients had no reasons (85%).
5. All twenty patients were treated previously with anterior packs (100%), they were treated with anterior and posterior packs (100%), four patients were treated using cauterization (20%) and none of them (0.0%) required blood transfusion (0.0%).
6. Three patients were treated with bilateral SPA cauterization (15%), six patients were treated with left SPA cauterization (30%), ten patients were treated right SPA cauterization (50%) and one (5%) was treated by right SPA cauterization under local anesthesia. Two patients were pregnant; one of them was in the first trimester and was operated under local anaesthesia, and the other was in the second trimester and was operated under general anaesthesia.
7. Three patients had moderate postoperative bleeding (15%), while the other 17 patients had no postoperative bleeding (85%).
8. One patient had trauma (33.33%), another one had both infection and trauma (33.33%), while the other case had no detected cause (33.33%).
9. By sinoscopic examination of the three cases with postoperative bleeding, the anterior ethmoidal artery (AEA) was found to be the source of postoperative bleeding and it was controlled by AEA cauterization.