DUAL LIGATION of the external carotid and anterior ethmoidal arteries in the initial surgical procedure for severe uncontrolled epistaxis has been performed numerous times, but scant mention of this combined operation appears in the literature. Oppenheim and his associates,1 in 1952, in a comprehensive review of the literature at their disposal recorded 17 cases (including 2 of their own) in which the anterior ethmoidal artery was surgically interrupted either primary or secondary to the external, internal, and/or common carotid arteries, and in only one instance, that of Williams2 in 1945, were the external carotid and anterior ethmoidal arteries ligated in one surgical session.
In 5 of the 17 cases recorded, ligation of the anterior ethmoidal artery alone stopped the hemorrhage. In eight cases (excluding that of Williams2) interruptions of the anterior ethmoidal artery were preceded by ligation of the external carotid artery at separate sessions, an interval