Anatomical variation of the posterior septal artery leads to refractory epistaxis

Purpose:To report a rare variant of the posterior septal artery(PSA),which supplies blood to the posterior mucosa of the contralateral nasal septum.Case report:A 31-year-old female patient underwent suture removal 14 days after septoplasty and developed left-sided epistaxis 6 h after suture removal.To safely and effectively relieve the patient from epistaxis,the cauterization of the left PSA was performed under general anesthesia.However,24 h after the first surgical hemostasis,the patient experienced epistaxis again in the right nasal cavity.We have reviewed the patient's sinus computed tomography again and found a rare variant of PSA,which is the right-sided PSA passing through a bony canal in the left-sided nasal septum.Discussion:The variant of PSA well explained the failure of the first hemostatic surgery.Therefore,we again performed a cauterization of the right-sided PSA,after which the patient recovered and no further epistaxis occurred.Conclusion:When cauterization of PSA is used to manage posterior epistaxis,it is necessary to pay attention to the possible variation in PSA.