Refractory epistaxis and Stamm's S-point.

PURPOSE OF REVIEW: Ethmoidal arteries are gaining increasing importance as the main source of severe refractory epistaxis. In this direction, Stamm's S-point, a specific bleeding point in the upper nasal septum, around the projection of the axilla of middle turbinate, posterior to the septal body, was recently described. The aim of this review was to present recent data on S-point and its role in severe refractory epistaxis. RECENT FINDINGS: Due to the hidden location posterior to the septal body, S-point is not easily identified by anterior rhinoscopy. When systematic endoscopic assessment was performed in severe epistaxis to search for the precise bleeding point, S-point was clearly the most identified (23.7-28.3%). Electrocauterization of bleeding point had high success rates (91.5-100%) and decreased the risk of recurrence bleeding. SUMMARY: Stamm's S-point plays an important role in severe refractory epistaxis, due to its frequency and stability. However, this specific bleeding point could not be easily identified, so systematic endoscopic assessment should be performed. Recent data has shifted the paradigm of the main source of severe epistaxis from the sphenopalatine artery to ethmoidal arteries and presented high success rates for electrocauterization of bleeding points as single treatment of severe epistaxis.