Background: Epistaxis is the bleeding from nose. It is a common complaint and it is the commonest 
emergency otolaryngologists' encounter. Epistaxis can be life- threatening due to aspiration, 
hypotension, and anemia as well as associated co-morbidities. Endoscopic control of sphenopalatine 
artery (SPA) has been advocated as an effective alternative for the control of sever epistaxis. Aim of 
the work: To evaluate effectiveness of endoscopic SPA cauterizations for control of sever epistaxis.
Patient and methods: The current study included 20 patients with severe posterior epistaxis. Patients 
with no response to anterior and posterior packing had undergone endoscopic SPA cauterization. 
Results: Fifteen percentage of patients (n=3) had moderate postoperative bleeding, while the other 
85% (n=17) had no postoperative bleeding. By endoscopic examination of the three cases with 
postoperative bleeding readmitted for control of epistaxis under general anesthesia, the anterior 
ethmoidal artery (AEA) was found to be the source of bleeding and it was controlled by AEA 
cauterization. Conclusion: Endoscopic SPA cauterization technique seems to be safe, simple, fast, 
and effective for management of severe epistaxis with low morbidity and complications. Endoscopic 
SPA cauterization should be considered as an immediate second-line management for sever epistaxis 
when conservative treatment as first-line management fails.