Targeting the Pterygopalatine Fossa: A Novel Approach to Minimize Intraoperative Bleeding in Endoscopic Sinus Surgery

Background and aim The appropriate surgical management for chronic rhinosinusitis or nasal polyps is endoscopic sinus surgery. However, owing to paranasal sinus vascularity, even a tiny amount of hemorrhage may significantly compromise vision at surgery. We aimed to evaluate the impact of injecting Xylocaine and adrenaline into the pterygopalatine fossa on surgical field bleeding and blood loss during functional endoscopic sinus surgery (FESS). Patients and methods A prospective, blinded randomized controlled trial was conducted. A total of 45 patients with symmetrical chronic rhinosinusitis who underwent FESS were enrolled in the study. Under general anesthesia, a unilateral injection of 2% lidocaine and 1 : 100 000 epinephrine into one of the pterygopalatine fossae; the side was selected randomly. The surgeon performing the procedure was blinded as to which side was infiltrated at the start of the surgery. Results There was a significant decrease in the injected side as regards the duration of surgery and amount of bleeding ( P <0.001). Also, there was a statistical improvement in the surgical grade of the infiltrated side ( P <0.001). Conclusion Infiltration of pterygopalatine fossa with 2% xylocaine and 1 : 100 000 adrenaline dramatically lowers bleeding and enhances surgical field visibility throughout FESS.