Endoscopic Anatomy of the Sphenopalatine and Posterior Nasal Arteries: Implications for the Endoscopic Management of Epistaxis

Schwartzbauer, Heather Rose; Shete, Mona; Tami, Thomas A.

doi:10.1177/194589240301700111

Cited by 70 publications

(81 citation statements)

References 21 publications

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“…If nasal pack for controlling severe epistaxis leads to pain and extreme discomfort and if nasal obstruction, dysphagia and occlusion of auditory tube are present and no response can be obtained from medication and pack therapy, arterial ligation is applied (Abelson et al; Maceri). Transanthral, transoral or endonasal endoscopic intervention methods are used for ligating the 3rd part of the maxillary artery and sphenopalatine artery (Stepnick et al, 1990;Abelson et al;Maceri;Voegels et al, 2001;Schwartzbauer et al;Kumar et al, 2003;Pradess et al, 2008;Abuzayed et al). Arterial embolization is used as an alternative and efficient method for persistent posterior epistaxis cases and it is performed under angiographic guidance (Maceri).…”

Section: Discussionmentioning

confidence: 99%

“…Although course and parts of the maxillary artery are defined in classical anatomy books, significant clinical information related with the main artery and its branches are included in several investigation reports (Navarro et al, 1982;Morton & Khan, 1991;Vrionis et al, 1996;Sashi et al, 1996;Choi & Park, 2003;Schwartzbauer et al, 2003;Isolan et al, 2007;Hussain et al, 2008;Abuzayed et al, 2009;Chiu, 2009;Kwak et al, 2010). As the most important contribution to the blood supply of the nose is made by maxillary artery from the external carotid system, it is reported that ligation of the maxillary artery and its branches via different procedures is the most efficient method for controlling the epistaxis (Stepnick et al, 1990;Abelson, 1991;Maceri, 1993;Abuzayed et al, 2009;Kwak et al, 2010).…”

Section: Introductionmentioning

confidence: 99%

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Clinical Significance of Maxillary Artery and its Branches: A Cadaver Study and Review of the Literature

et al. 2011

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SUMMARY:The aim of this study was to investigate the anatomy of the maxillary artery (MA) and its branches. Fourteen sides of Turkish adult cadavers were dissected. The specimens were classified according to the relation between MA and the lateral pterygoid. After the removal of the lateral pterygoid, parts and branches of MA were exposed. We classified the branching patterns of MA in the pterygopalatine fossa. The calibers and lengths of the arteries, and the distance between the zygomatic arch and MA, and between the infratemporal crest and MA were measured. The MA was found superficial to the lateral pterygoid in 57.2%. The inferior alveolar artery (IA) was arisen from MA before the middle meningeal artery (MM) in 35.7%, after MM in 35.7%. The IA and MM were arisen from the same area of MA in 14.3 %. In other two cases IA was arisen from the beginning of MA (14.3%). According to the contours of third portion of MA, we classified "Y" type (50%), "intermediate-T" type (14.3%), and "M" type (35.7%). This reinvestigation of the clinical anatomy of MA may provide useful information to the head and neck surgeons, dentists, neurosurgeons and radiologists related with this region.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Clinical Significance of Maxillary Artery and its Branches: A Cadaver Study and Review of the Literature

et al. 2011

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“…This helped in the stoppage of the bleeding in many cases. There are many other methods that can be applied for the treatment of these cases, like lasers [11,13,14], cryotherapy, endoscopic ligation of the sphenopalatine artery [15], and endoscopic ligation of the ethmoidal arteries [15,16]. As these facilities were not available in our hospital, the above mentioned procedures were not done.…”

mentioning

confidence: 99%

Rigid Nasal Endoscopy in the Diagnosis and Treatment of Epistaxis

Kumar

Prasad²,

Gowda³

2013

JCDR

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Background and Objectives: Epistaxis is one of the common symptoms encountered in the Otorhinolaryngology department. Many times the cause for epistaxis is not found on anterior and posterior rhinoscopy. The present study was undertaken to assess the role of rigid nasal endoscope in the diagnosis and treatment of epistaxis, where normal anterior and posterior rhinoscopy did not reveal any specific finding.Methods: Fifty patients with epistaxis were studied using rigid nasal endoscope under local anaesthesia. Patients who were above 15 years with nasal bleeding and who were willing for rigid nasal endoscopy were included in the study. Patients less than 15 years were not included in the study because nasal endoscopy was difficult in them under local anaesthesia. Only those patients in whom, the cause for epistaxis could not be made out on anterior and posterior rhinoscopy were chosen for the study, this was done in order to remove the bias for nasal endoscopy. Results:The use of the nasal endoscope allowed diagnosis of bleeding points and treating them directly. Epistaxis was more in male patients especially in the 3 rd and after the 5 th decade. On endoscopic examination,the bleeding points were identified as coming from the crevices of the lateral nasal wall, posterior spur on the septum, posterior deviation of the septum with ulcer, congested polyps, enlarged and congested adenoids, scabs or crusts in the crevices of the lateral nasal wall and angiofibroma. Endoscope also helps in the treatment of epistaxis, which includes endoscopic selective nasal packing using gelfoam, endoscopic cautery or diathermy and endoscopic polypectomy. Other patients with adenoids, scabs and crusts and angiofibroma were managed on their merits. Interpretation and Conclusion:Nasal endoscopy helps not only in the localisation of the bleeding point but also in the treatment of those bleeding areas that are situated in the posterior and lateral part of the nose.

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“…[9][10][11] It is important to consider that certain anatomic variations exist in the blood supply of the sphenopalatine artery, one of which is that the posterior lateral nasal artery may extend anteriorly to the posterior wall of the maxillary antrum. 12,13 This variant in particular is important to recognize in avoiding injury to the vascular pedicle when performing the maxillary antrostomy and mucoperiosteal elevation.…”

Section: Surgical Techniquementioning

confidence: 99%

Endoscopic Endonasal Reconstructive Methods to the Anterior Skull Base

Chakravarthi

Gonen

Monroy-Sosa

et al. 2017

Seminars in Plastic Surgery

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Endoscopic approaches and techniques to the anterior skull base, sellar, and parasellar regions have contributed significantly to the field of skull base surgery, facilitating the resection of complex skull base lesions with a minimal surgical footprint. The most clinically significant complication with these approaches has been the incidence of postoperative cerebrospinal fluid (CSF) leak. 1 Once the initial feasibility and efficacy were established, demonstrating improved neurological outcomes, reconstruction, CSF leaks became the primary challenge. The expanded endoscopic endonasal approach (EEA) followed the same progression as open skull base surgery such that reconstruction from grafts to vascularized flaps allowed a concomitant reduction in CSF leak rates, which are now in the range of 1 to 5%. [2][3][4] The EEAs have been organized into the following corridors along the coronal and sagittal planes, which span the entire ventral anterior, middle, and posterior cranial fossa, providing access via a series of modular approaches; specifically, the transfrontal, transcribriform, transplanum-transtuberculum, transsellar, transclival, transodontoid, and respective coronal modules. 5 The reconstruction is primarily dependent on the anatomic region and module undertaken relative to the availability of local and regional vascularized pedicled flaps. Several attempts at categorizing reconstruction options have been described, the most notable is by Patel et al. 6 There exists significant literature on the use of grafts, and as stated, as the EEA approaches evolved, so has the reconstruction from grafts to flaps. To avoid reiteration, in this article, we outline a pragmatic algorithmic approach focused exclusively on vascularized flap reconstruction; explicitly, we share with the readers our specific reconstruction algorithm that we have been using over the past decade to AbstractThe success of expanded endoscopic endonasal approaches (EEAs) to the anterior skull base, sellar, and parasellar regions has been greatly aided by the advancement in reconstructive techniques. In particular, the pedicled vascularized flaps have been developed and effectively cover skull base defects of varying sizes with a significant reduction in postoperative CSF leaks. There are two aims to this review: (1) We will provide our current, simplified reconstruction algorithm. (2) We will describe, in detail, the relevant anatomy, indications/contraindications, and surgical technique, with a particular emphasis on the nasoseptal flap (NSF). The inferior turbinate flap (ITF), middle turbinate flap (MTF), pericranial flap (PCF), and temporoparietal fascial flap (TPFF) will also be described. The NSF should be the primary option for reconstruction of majority of skull base defects following endonasal endoscopic surgery. In general, for the planum, cribriform, and upper two-thirds of the clivus, the NSF is ideal. For the lower-third of the clivus, the NSF may not be adequate and may require additional reconstructive options. Although limited in...

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Endoscopic Anatomy of the Sphenopalatine and Posterior Nasal Arteries: Implications for the Endoscopic Management of Epistaxis

Abstract: Understanding this anatomic relationship is important in performing endoscopic arterial ligation. If the sphenopalatine artery is not specifically identified and ligated, an important component of the posterior nasal circulation will not be addressed adequately by this surgical approach.

Cited by 70 publications

References 21 publications

Clinical Significance of Maxillary Artery and its Branches: A Cadaver Study and Review of the Literature

Clinical Significance of Maxillary Artery and its Branches: A Cadaver Study and Review of the Literature

Rigid Nasal Endoscopy in the Diagnosis and Treatment of Epistaxis

Endoscopic Endonasal Reconstructive Methods to the Anterior Skull Base

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