Management of uncontrolled/recurrent epistaxis by ligation or cauterization of the sphenopalatine artery: a scoping review.

PURPOSE: The control of epistaxis has always posed a significant challenge for otolaryngologists. One of the most viable options to address refractory cases is the ligation or cauterization of the sphenopalatine artery. The objective of this study was to assess the efficacy, safety, and long-term outcomes of these interventions. MATERIALS AND METHODS: Two independent otolaryngologists conducted a comprehensive search for studies dealing with management of uncontrolled/recurrent epistaxis by consulting the main scientific databases on the web, including PubMed, Google Scholar, Medline, EMBASE, Web of Science, and the Cochrane Library. The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. The criteria for considering studies for the review were based on the population, intervention, comparison, outcome, timing and setting (PICOTS) framework. RESULTS: Sixteen studies were included in the systematic review, comprising a total of 454 patients. Among these, 289 individuals underwent ligation of the sphenopalatine artery, while 100 underwent cauterization of the same artery. Additionally, 56 patients underwent both ligation and cauterization of the sphenopalatine artery during the same surgery. The incidence of rebleeding and complications was respectively 12.1% (55/454) and 3% (14/454), resulting in relatively low rates in both cases. CONCLUSIONS: Our review emphasizes the increasing importance of surgical approaches, specifically ligation or cauterization of the sphenopalatine artery, in addressing refractory cases. The low incidence of complications, predominantly temporary decreased lacrimation in patients undergoing ligation of the sphenopalatine artery, highlights the safety and feasibility of these interventions.

Tonsillar Kaposi's Sarcoma in HIV Positive Patient with Syphilis Infection.

Introduction: Since the introduction of Highly Active Anti-Retroviral Therapy (HAART), there has been a significant increase in the survival of HIV-infected patients. Consequently, there has been increased attention on the potential neoplastic pathologies, such as Kaposi's sarcoma, associated with AIDS in these individuals. Case Report: In this case report we present, for the first time, a patient affected by Kaposi's sarcoma of the palatine tonsil with a concomitant syphilis infection. The patient underwent enlarged tonsillectomy and continued antiretroviral therapy. There were no signs of disease recurrence at a 12-month follow-up. Conclusions: Despite the rarity of tonsillar localization of Kaposi's sarcoma, it should be suspected in the presence of an HIV-infected patient. Tonsillectomy effectively controls local disease, but comprehensive patient management requires a multidisciplinary team of healthcare professionals, including infectious disease specialists, pathologists, and oncologists who work together to provide high-quality and coordinated care.