Tespal surgery

ENT surgery

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

2. 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

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

4. MANAGEMENT

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

6. 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

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

8. 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

9. 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

10. COMPLICATIONS Palatal numbness Sinusitis Decreased lacrimation Septal perforation Inferior turbinate necrosis

11. Thank you