Ligation of the anterior ethmoidal artery is commonly performed in patients with a history of trauma; in the absence of trauma, ligation of the sphenopalatine artery is often first considered.
The course of the anterior ethmoidal artery is variable, and cadaveric studies have confirmed that the location of the ethmoidal canal is variable, sitting attached to or below the skull base, in some cases via a thin bony mesentery.
Hence, information regarding the location of the anterior ethmoidal artery from imaging is not available preoperatively.
Anterior ethmoidal artery ligation should be considered as a primary procedure in patients whose epistaxis follows a history of head trauma.
Once the patient is stabilized and has been transported to the tertiary care center, several treatment approaches can be used, such as transnasal endoscopic anterior ethmoidal artery
ligation, (6) clipping of the bleeding artery, (5) cauterization, (4) or endoscopic ablation and angiographic embolization, (2,3) all of which have been reported to be successful.