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Case Reports
. 2023 Jul 4;10(3):241-243.
doi: 10.1002/wjo2.113. eCollection 2024 Sep.

Anatomical variation of the posterior septal artery leads to refractory epistaxis

Dong-Jiao An  1 , Zu-Fei Li  2 , Xiao-Chang Zhao  2 , Jin-Feng Liu  2
Affiliations
Case Reports

Anatomical variation of the posterior septal artery leads to refractory epistaxis

Dong-Jiao An et al. World J Otorhinolaryngol Head Neck Surg. .

Abstract

Purpose: To report a rare variant of the posterior septal artery (PSA), which supplies blood to the posterior mucosa of the contralateral nasal septum.

Case report: A 31-year-old female patient underwent suture removal 14 days after septoplasty and developed left-sided epistaxis 6 h after suture removal. To safely and effectively relieve the patient from epistaxis, the cauterization of the left PSA was performed under general anesthesia. However, 24 h after the first surgical hemostasis, the patient experienced epistaxis again in the right nasal cavity. We have reviewed the patient's sinus computed tomography again and found a rare variant of PSA, which is the right-sided PSA passing through a bony canal in the left-sided nasal septum.

Discussion: The variant of PSA well explained the failure of the first hemostatic surgery. Therefore, we again performed a cauterization of the right-sided PSA, after which the patient recovered and no further epistaxis occurred.

Conclusion: When cauterization of PSA is used to manage posterior epistaxis, it is necessary to pay attention to the possible variation in PSA.

Keywords: cauterization; nasal endoscopy; posterior septal artery; refractory epistaxis; sphenopalatine artery.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
A picture shows the nasal septum in a suture state at the end of the septoplasty. The white arrow indicates the bleeding point on the right side of the NS. IT, inferior turbinate; NS, nasal septum.
Figure 2
Figure 2
CT shows the anatomical variation of the PSA. The right PSA passed through a bony canal in the posterior of the nasal septum to the left side (the white arrows indicated in A). The arrow in (A–D) indicates the PSA traveling process. The exit point of PSA at the left side of the nasal septum is located behind the nasal septal spur (D). CT, computed tomography; PSA, posterior septal artery.
See this image and copyright information in PMC

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