The injecting of the greater palatine canal has been documented for some time. The authors in this paper expand this to the more common procedure of the septoplasty. They summarise the pros and cons published regarding the technique in sinus surgery well and address concerns about blindness caused by the vasoconstriction of the ophthalmic artery. They manage to put together a novel double blinded control trial by using blinded assessors intraoperatively to grade the extent of bleeding. They compared the use 2mls of 1% lidocaine with 1:100,000 epinephrine trans-nasally along with an additional 2mls of 1% lidocaine with 1:100,000 epinephrine injected into the greater palatine foramen against the same local anaesthetic with vasoconstrictor solution trans-nasally. They recruited a total of 25 patients to each arm with comparable baseline pathology and demographics. Their results show significant differences m=both objectively and subjectively in the amount of blood lost. They published a mean blood loss of 34.64mls in the treatment group and 100.48mls in the control group. There could be an argument as to the clinical relevance of 100mls v 30mls of blood loss although the reduction of blood may have improved the visual field. The technique is simple and especially in patients who do bleed it could have a beneficial effect on surgery if used intraoperatively when required as much as in routine practice.

Epinephrine injection in greater palatine canal: an alternative technique for reducing haemorrhage.
Dadgarnia MH, Shahbazian H, Behniafard N, et al.
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Stuart Burrows

FRCS (ORL-HNS), Wellington Regional Hospital, Newtown, Wellington, New Zealand.

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