If posterior epistaxis cannot be controlled, which aery is ligated:
Ligation technique is reserved for intractable bleeding where the source cannot be located or controlled by other techniques. The hierarchy of aeries used for ligation is: Sphenopalatine aery Internal maxillary aery External carotid Aery Anterior/posterior ethmoidal aery Earlier the most common aery ligated was maxillary aery but now endonasal sphenopalatine aery ligation (ESPAL) is the ligation of choice
Posterior ethmoidal aery
Maxillary aery
Sphenopalatine aery
External carotid aery