The Artery You Don’t Need to Fear: Endoscopic Anterior Ethmoid Artery Ligation for Recalcitrant Epistaxis.

PROGRAM DESCRIPTION: Traditionally, the trans-orbital approach to the anterior ethmoid artery is taught as the means to manage epistaxis recalcitrant to sphenopalatine artery ligation or embolization. With the rise of advancing endoscopic skull base techniques and increased exposure to complex frontal sinus surgery in surgical training, the otolaryngologist’s relationship with the anterior ethmoid artery is transitioning from fear to respect. In this session, there will be a demonstration of an endoscopic anterior ethmoid artery ligation to highlight the procedure as an approachable management option for recalcitrant epistaxis. We will review the anatomy of the anterior ethmoid artery and its variations along the skull base and how preoperative imaging can guide both the decision to operate and intraoperative surgical decision making. We will highlight intraoperative skull base and orbit landmarks as a means of identifying the artery in conjunction with image guided navigation. A dissection of the artery and specific instruments useful to the procedure will be discussed and demonstrated. Finally, complications of the procedure will be discussed and how the Otolaryngologist can manage and consider these known complications of any endoscopic sinus surgery.