Introduction
Epistaxis is a common paediatric presentation, with the majority of cases managed conservatively. In refractory cases, sphenopalatine artery (SPA) ligation offers a minimally invasive surgical option with an established evidence base in adults. However, data in the paediatric population remain limited, and a proportion of affected children have underlying haematological or coagulation disorders. This case series reports our experience with endoscopic SPA ligation at a tertiary paediatric centre.
Methods
A retrospective case series of all paediatric patients undergoing endoscopic SPA ligation at Great Ormond Street Hospital was performed. Fifteen procedures were carried out in 13 patients. Two patients underwent staged bilateral SPA ligation as separate planned procedures, rather than representing recurrence. Patient-reported symptomatic outcomes and complications were recorded.
Results
Thirteen patients underwent 15 SPA ligation procedures in total. Four patients (31%) had pre-existing haematological or coagulation defects. Twelve of 13 patients (92%) reported significant symptomatic improvement following surgery. One patient (8%) reported no improvement. No significant perioperative or postoperative complications were recorded in any patient, including those with underlying coagulopathy.
Conclusion
Endoscopic SPA ligation is an effective and well-tolerated intervention for refractory paediatric epistaxis, with a high rate of symptomatic improvement and a favourable safety profile, including in those with coagulation disorders. This series from a specialist paediatric centre supports its broader application in children and adds to the limited evidence base in this age group. Larger prospective studies are warranted to further define outcomes and refine patient selection