Background: Recurrent epistaxis affects approximately 9% of children and is typically managed using topical therapies and silver nitrate cautery. Surgical intervention is reserved for refractory cases; however, there is limited evidence regarding the optimal surgical approach.
Methods: A scoping review was conducted according to a prospectively registered protocol (Open Science Framework registration ID: 9mfxz). MEDLINE, Embase, and the Cochrane Library were searched from inception to December 2025. Studies reporting surgical management of recurrent epistaxis in children (<18 years) were included. The primary outcome was recurrent epistaxis following surgery.
Results: Twelve studies comprising 553 paediatric patients met the inclusion criteria. The weighted mean age was 10.3 years. Prior to surgery, 76 patients had undergone silver nitrate cautery and 46 had received topical antiseptic cream. Coagulopathy status was variably reported, with 24 patients (4.3%) documented to have an underlying coagulopathy. Bipolar or electrical cautery was the most frequently reported intervention (225 exposures) and was associated with a recurrence rate of 19.1%. Radiofrequency coagulation demonstrated the lowest recurrence rate (2.4%; 2/83 patients), followed by microwave ablation (7.4%; 10/135 patients). Laser therapy demonstrated a recurrence rate of 26.8% (11/41 patients), while sphenopalatine artery ligation demonstrated a recurrence rate of 33.3% (4/12 patients). Overall recurrence following surgical intervention was 13.9% (72/517). No mortality was reported.
Conclusions: The literature describing surgical management of recurrent paediatric epistaxis remains limited and heterogeneous. Radiofrequency coagulation and microwave ablation demonstrated the lowest reported recurrence rates. Further prospective comparative studies are required to determine the optimal surgical management strategy.