External Carotid Artery Ligation for the Management of Massive Post-Tonsillectomy Bleeding: A Report of Six Cases

Background: Post-Tonsillectomy Bleeding (PTB) is the most common and significant complication following tonsillectomy. It could be delayed and recurrent with massive blood loss requiring surgical treatment. External carotid artery (ECA) ligation is the method of choice to control such massive PTB. Material and Methods: This study was conducted as a retrospective analysis for six cases with massive PTB in whom ECA ligation was performed between January 2004 and December 2007. A particular concern was paid for the level of ECA ligation and the need for individual branches (lingual and facial arteries) ligation. Results: The onset of massive PTB ranged between 5 and 27 days following tonsillectomy. Four patients had PTB delayed beyond 2 weeks. Repeated bleeding episodes were prevalent in four patients. The ECA was always ligated above the level of the lingual artery. Four patients required individual branches ligation. Conclusion: Massive PTB may occur as delayed bleeding with recurrent bleeding episodes. Rapid ECA ligation is effective and could avoid lethal sequale. Higher level of ECA ligation with individual branches ligation should be always considered.