Anatomical and surgical study of the sphenopalatine artery branches

Morphometric analysis of sphenopalatine foramen on computed tomography images with clinical significance

PURPOSE

This study aimed to investigate the effect of anatomical variations in the sphenopalatine foramen and the lateral nasal wall on sphenopalatine foramen-related morphometric measurements.

METHODS

Paranasal sinus multidetector computed tomography records of 153 patients were evaluated. Morphometric measurements were made between the fixed bony landmarks and the sphenopalatine foramen. Number, shape, localization variations of the sphenopalatine foramen, concha bullosa, and septum deviation were noted and the results were compared with respect to sex, age, and laterality.

RESULTS

No significant difference was detected with respect to laterality, whereas most of the measured distances were higher in males than females. There was a significant difference between the obtained morphometric data according to age groups. In our study, 91.2% single, 7.8% double, and 1% triple sphenopalatine foramen were detected and the most common irregularly shaped (37.3%). The location of sphenopalatine foramen was reported as the most common type II. Septum deviation types have no potential influence on the location of the foramen, but most of the measured parameters were found to be significantly smaller in the presence of concha bullosa, whereas the angle was found to be higher.

CONCLUSION

This study revealed a significant relationship between the morphometric measurements of the sphenopalatine foramen and concha bullosa, while septum deviation types did not affect these results. For a safer and more effective surgery with prevention of iatrogenic complications, a surgeon should be aware of this correlation, especially in endoscopic transnasal approaches.

Relationship between the posterior septal artery and the upper edge of the choana

BACKGROUND

The pedicled nasoseptal flap has been a key element in advancing the endoscopic transnasal approach (ETA) for the treatment of skull base lesions from the anterior cranial fossa to the occipitocervical junction. To preserve vascular supply, an anatomical knowledge of the location of the posterior septal artery (PSA) is essential. The objective of this work is to establish the relationship between PSA and the superior edge of the choana to define a safety margin during the opening of the sphenoidal rostrum preserving PSA.

METHODS

One hundred and eighty angiotomographies of the brain were assessed. The sphenopalatine artery (SPA) was evaluated in the pterygopalatine fossa and PSA at its entrance into the nasal cavity and on the sphenoidal rostrum.

RESULTS

PSA was found in all 3 tomographic planes (axial, coronal and sagittal) in 100 patients (200 PSAs). Thirty-five were male and 65 were females. Average age was 62 years with a range of 19-90 years. Total average distance between PSA and the superior edge of the choana was 8.5 mm with a range of 2.5-18 (12.45 90th percentile).

CONCLUSION

Although the distance between the choanal edge and PSA is 8.5 mm on average, due to its variability, a distance of at least 12.45 mm for the opening of the sphenoidal sinus in the ETA approach should be considered as a safety margin.

Anatomical Correlation Between Nasal Vascularisation and the Design of the Endonasal Pedicle Flaps

Arteries that supply the nasal septum and the lateral nasal wall include vessels that originate from the external carotid artery and from the internal carotid artery. A variety of local endonasal pedicle flaps can be used in different anatomical areas for endoscopic skull base reconstruction. The main flaps are based on terminal branches of the sphenopalatine artery and on anterior ethmoidal artery. This study will describe the anatomy of these vessels and their relationship with the main flaps.