Landmarks for Rapid Localization of the Sphenopalatine Foramen: A Radiographic Morphometric Analysis

Abstract

Background:Transnasal endoscopic sphenopalatine artery ligation is becoming the procedure of choice for surgical management of intractable posterior epistaxis. Landmarks for localization of the sphenopalatine foramen can assist in rapid surgical exposure of the sphenopalatine artery.Objective:This study examined distances from easily identified endoscopic surgical landmarks to the sphenopalatine foramen.Methods:By using computed tomography of the sinus to study radiologic anatomy in 50 adults, distances were measured between five simple endoscopic landmarks and the sphenopalatine foramen. The two-tailed t-test was used for statistical analysis.Results:Right- and left-sided measurements were similar. The mean (standard deviation [SD]) anteroposterior distances to the sphenopalatine foramen were the following: from the maxillary line (36.7 ± 5.5 mm), anterior head of the middle turbinate (33.8 ± 6.7 mm), basal lamella (11.8 ± 1.9 mm), and choanal arch (−9.2 ± 1.4 mm). The mean (SD) distance in the vertical dimension from the nasal floor was 26.6 ± 2.6 mm. Female patients had statistically shorter distances to the sphenopalatine foramen from the maxillary line, anterior head of the middle turbinate, choanal arch, and nasal floor.Conclusion:Reliable endoscopic landmarks exist in relation to consistent anatomic structures and can be used to help quickly estimate the location of the sphenopalatine foramen at the onset of the procedure.

Transnasal Endoscopic Sphenopalatine Artery Ligation Compared With Embolization for Intractable Epistaxis: A Long-term Analysis

“…Surgical ligation of the internal maxillary artery or external carotid artery has been the historically preferred treatment method, 1 but endovascular embolization has recently emerged as a viable and effective treatment alternative. 2,3 On the other hand, advancements in endoscopic surgery have enabled selective ligation such as transnasal endoscopic sphenopalatine artery ligation (TESPAL). 4 The literature provides some insight into selecting the ideal treatment option, which can be challenging.…”

A Morphometric Study of the Sphenopalatine Foramen and its Clinical Implication in Transnasal Sphenopalatine Ganglion Block

“…The dimensions of the SPF (3.79-6.44 mm) were smaller than those reported in the literature (4.62-6.8 and 7.5-9.35 mm) 16,17 . Also, the vertical distance between the SPF and palatum durum (or nasal floor) was reported as 15.58 mm that is less than those reported in the literature ranging from 18.27 to 26.6 mm 8,18 . Hadoura reported an angle of elevation of the SPF from the nasal floor of 22.5° in his computed tomography guided surgical navigation study 13 .…”

Morphometric and Clinical Evaluation of Sphenopalatine Foramen on Computed Tomography Images

“…Epistaxis is a common condition faced by ENT specialists in the clinic. Most cases can be conservatively controlled with nasal packing or direct cautery, however, arterial ligation is the most common surgical treatment option for dangerous and recurrent posterior epistaxis [9,10,12]. The SPA ligation was most commonly preferred method with a high success rate (89%), which can be explained by end artery and very little collateral circulation.…”

“…In addition, di culties may arise in determining the SPF during the ligation procedure in patients, who still have active hemorrhage despite medical anticoagulation or multiple rounds of nasal packings. Therefore, a surgeon must be aware of the surgical anatomy of the SPF and possible complications of the SPA ligation [1,4,10,16].…”

“…Therefore, the identi cation of xed anatomical landmarks in computed tomography (CT) images makes it easier to determine a more accurate incision location with the removal of a smaller mucoperiosteal ap directly over the SPF and to identify the SPA [10]. Some studies have shown that there are many variations of the shape and number of the SPF [5].…”