How is arterial ligation performed on the external carotid artery in the treatment of epistaxis (nosebleed)?

Updated: May 08, 2020
  • Author: Quoc A Nguyen, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Ligation of the external carotid artery (ECA) can be performed with the patient under local or general anesthesia. A horizontal skin incision is made between the hyoid bone and the superior border of the thyroid cartilage. Subplatysmal skin flaps are then raised, and the sternocleidomastoid muscle is retracted posteriorly.

Next, the carotid sheath is opened and its contents exposed. The ECA is identified by following the internal carotid artery (ICA) for a few centimeters and dissecting the ECA beyond its first few branches. After the ECA has been positively identified, it is usually ligated just distal to the superior thyroid artery. Continued bleeding after ligation may be from anastomoses with the opposite carotid system or the ipsilateral ICA.

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