This document discusses Transnasal endoscopic Sphenopalatine artery ligation (TESPAL) as a treatment for refractory epistaxis. It describes the common sites of epistaxis including Little's area and branches of the sphenopalatine artery. TESPAL involves using an endoscope to make an incision near the middle turbinate, retracting tissue to expose the sphenopalatine artery which is then cauterized to stop bleeding. Potential complications include palatal numbness, sinusitis, and septal perforation. TESPAL is indicated for arterial bleeding that is difficult to control with nasal packing.

1. Transnasal endoscopic
Sphenopalatine artery ligation
(TESPAL)
Prepared by
Annampalli yuvasree-
13

3. Sites of epistaxis
• Little’s area
• Above the level of middle turbinate
• Below the level of middle turbinate –here the
bleeding is from the
branches of sphenopalatine artery
It maybe Hidden ,lying lateral to middle or inferior
turbinate
• Posterior part of nasal cavity
• Nasopharynx

4. TYPES OF EPISTAXIS
• Anterior –Mostly from littles area
• Posterior-mostley from posterosuperior part of nasal
cavity,often
often difficult to localize the Bleeding point

5. MANAGEMENT

6. TESPAL
• The procedure was first reported
by budrovich and Saetti in 1992

7. INDICATIONS
• Treatment of epistaxis refractory to nasal packing
• Control of arterial bleeding encountered during nasal
or sinus surgery
• Arterial control for vascular tumor resection
Example-JNA

8. PROCEDURE
Nose should first be decongested
Nasal endoscope is introduced
into the nasal cavity

9. An incision ranging between 10-20mm
Is made vertically about 5mm anterior to the
Attachment of the middle turbinate
Mucosal flap is gently retracted posteriorly
till the crista ethmoidalis visualised

11. The sphenopalatine artery is
Cauterized
Following successful ligation/cauterisation the area is
explored posteriorly for 2-3mm to ensure that no more
vessels remain uncauterized

13. COMPLICATIONS
1. Palatal numbness
2. Sinusitis
3. Decreased lacrimation
4. Septal perforation
5. Inferior turbinate necrosis

14. Thank you