Downloaded from http://journals.lww.com/co-otolaryngology by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC1y0abggQZXdgGj2MwlZLeI= on 12/27/2021 Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved. C URRENT O PINION Refractory epistaxis and Stamm’s S-point Eduardo Macoto Kosugi a , Leonardo Balsalobre a,b , and Aldo Cassol Stamm b Purpose of review Ethmoidal arteries are gaining increasing importance as the main source of severe refractory epistaxis. In this direction, Stamm’s S-point, a specific bleeding point in the upper nasal septum, around the projection of the axilla of middle turbinate, posterior to the septal body, was recently described. The aim of this review was to present recent data on S-point and its role in severe refractory epistaxis. Recent findings Due to the hidden location posterior to the septal body, S-point is not easily identified by anterior rhinoscopy. When systematic endoscopic assessment was performed in severe epistaxis to search for the precise bleeding point, S-point was clearly the most identified (23.7–28.3%). Electrocauterization of bleeding point had high success rates (91.5–100%) and decreased the risk of recurrence bleeding. Summary Stamm’s S-point plays an important role in severe refractory epistaxis, due to its frequency and stability. However, this specific bleeding point could not be easily identified, so systematic endoscopic assessment should be performed. Recent data has shifted the paradigm of the main source of severe epistaxis from the sphenopalatine artery to ethmoidal arteries and presented high success rates for electrocauterization of bleeding points as single treatment of severe epistaxis. Keywords cautery, electrocoagulation, endoscopy, epistaxis INTRODUCTION Refractory epistaxis is always a distressing event for patients and clinicians that could be potentially life- threatening depending on its severity, requiring immediate and urgent management. The main source of severe refractory epistaxis is traditionally related to sphenopalatine artery (SPA); however, the ethmoidal arteries (EA) are gaining increasing importance. In this direction, Kosugi et al. [1] recently described the Stamm’s S-point, a specific bleeding point in the upper nasal septum that could be found frequently when detailed assessment of the nasal cavity by nasal endoscopy is performed [2 & ]. The aim of this review was to present recent data on Stamm’s S-point and its role in severe and refractory epistaxis. THE HISTORY OF STAMM’S S-POINT In his lectures, Dr Aldo Stamm used to talk about a frequent specific bleeding point in the upper nasal septum, around the projection of the middle turbi- nate’s axilla, posterior to the septal body, that pre- sented an arterial vascular pedicle with active bleeding (Fig. 1). Based on this information, three Brazilian ENT centers (Sa˜o Paulo Hospital of Federal University of Sa˜o Paulo, Sa˜o Paulo ENT Center of Edmundo Vasconcelos Hospital Complex, and Bot- afogo Polyclinic) started to search for this specific bleeding point in severe epistaxis since 2016, result- ing in the original description of Stamm’s S-point. This group presented nine patients with Stamm’s S- point severe epistaxis who were properly treated exclusively by electrocauterization of the bleeding point [1]. After that and inspired by the same lec- tures, Turri-Zanoni et al. [3] collected data from three Italian ENT centers to report 30 severe epi- staxis from septal branches of the anterior ethmoi- dal artery (sbAEA), identified on the septum side of olfactory cleft at the level of the middle turbinate’s axilla, exactly the same topography of the previ- ously described Stamm’s S-point [1]. Those patients a Rhinology Section, Otorhinolaryngoly and Head and Neck Surgery Department, Federal University of Sa˜o Paulo (UNIFESP-EPM) and b Sa˜o Paulo ENT Center (COF), Edmundo Vasconcelos Hospital Complex, Sa˜o Paulo, SP, Brazil Correspondence to Eduardo Macoto Kosugi, Avenida Rouxinol, 84, cj 123, Moema, Sa˜ o Paulo, SP 04516-000, Brazil. Tel: +55 11 25973340; e-mail: edumacoto@rinoepm.com Curr Opin Otolaryngol Head Neck Surg 2022, 30:13–18 DOI:10.1097/MOO.0000000000000773 1068-9508 Copyright ß 2021 Wolters Kluwer Health, Inc. All rights reserved. www.co-otolaryngology.com REVIEW