The importance of the anterior ethmoidal artery in idiopathic epistaxis: a retrospective study.

Abstract

Purpose: Data that compare the anterior ethmoidal artery (AEA) with the sphenopalatine artery (SPA) in epistaxis are limited. We intended to compare features of idiopathic epistaxis due to the anterior ethmoidal artery (AEA-epistaxis) with features of idiopathic epistaxis due to the sphenopalatine artery (SPA-epistaxis).

Methods: We conducted a retrospective review of subjects that were hospitalized due to epistaxis between 1st January 2017 and 31st December 2024 at the University Department of Otorhinolaryngology.

Results: In 113 subjects with idiopathic epistaxis, 61 (54%) subjects presented with SPA-epistaxis and 27 (24%) with AEA-epistaxis. The most frequent AEA-epistaxis site was the Stamm's S point (23/27), with the anterior nasal roof following (4/27). Subjects with SPA-epistaxis needed less often (13%) blood transfusion compared to subjects with AEA-epistaxis (30%; p < 0.001). Type of anesthesia differed significantly between subjects with SPA-epistaxis (100% general anesthesia) and subjects with Stamm' S point AEA-epistaxis (30% local anesthesia; p < 0.001). More subjects with initial SPA-epistaxis were re-admitted with severe epistaxis on the same nasal side (4.9%) than subjects with initial AEA-epistaxis (0%; p > 0.2).

Conclusion: In every fourth patient, idiopathic epistaxis might originate from septal branches of AEA, i.e., the Stamm's S point or the anterior nasal roof. Otorhinolaryngologists should not neglect looking for AEA branches during epistaxis. Delay of identification might result in higher blood transfusion rates. In contrast to the SPA, Stamm's S point can be occasionally addressed under local anesthesia, with very low re-admission rates.