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Kang BM, Oh HJ, Ryu KH, Ahn JM. Treatment of pituitary adenoma with spontaneous cerebrospinal rhinorrhea using nasoseptal flap, two case reports. Surg Neurol Int 2022; 13:262. [PMID: 35855160 PMCID: PMC9282767 DOI: 10.25259/sni_61_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 05/21/2022] [Indexed: 11/06/2022] Open
Abstract
Background: Postoperative cerebrospinal fluid (CSF) leakages are well documented, but pituitary adenoma with spontaneous CSF rhinorrhea as the initial symptoms are extremely rare. The objective of this study is to report two rare cases of pituitary adenoma with spontaneous CSF rhinorrhea successfully operated by endoscopic transsphenoidal approach with vascularized nasoseptal flap (NSF). Case Description: A 70-year-old woman presented with a 6-month history of watery rhinorrhea and posterior nasal drip that worsened when her head leaning forward. Sella magnetic resonance image (MRI) demonstrated pituitary macroadenoma (3.4 × 2.7 cm) invading cavernous sinus, clivus, and sphenoid sinus. A 47-year-old woman presented with a 10-month history of watery rhinorrhea and posterior nasal drip. Sella MRI demonstrated pituitary macroadenoma (6.3 × 4.6 cm) invading cavernous sinus, clivus, sphenoid sinus, and middle fossa. Both patients underwent endoscopic endonasal transsphenoidal operation and skull base reconstruction with vascularized NSF. The postoperative clinical course was uneventful and CSF rhinorrhea disappeared completely. Conclusion: Pituitary adenoma should be suspected if there is a watery CSF rhinorrhea that occurs without a history of trauma or nasal disease. In addition, effective treatment can be performed using NSF, a technique for endoscopic skull base reconstruction.
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Affiliation(s)
- Beom Mo Kang
- Department of Neurosurgery, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea,
| | - Hyuk-Jin Oh
- Department of Neurosurgery, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea,
| | - Kwang-Hui Ryu
- Department of Otorhinolaryngology, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea
| | - Jae-Min Ahn
- Department of Neurosurgery, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea,
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Griffiths CF, Barkhoudarian G, Cutler A, Duong HT, Karimi K, Doyle O, Carrau R, Kelly DF. Analysis of Olfaction after Bilateral Nasoseptal Rescue Flap Transsphenoidal Approach with Olfactory Mucosal Preservation. Otolaryngol Head Neck Surg 2019; 161:881-889. [PMID: 31331243 DOI: 10.1177/0194599819861340] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To ascertain the impact of septal olfactory strip preservation and bilateral rescue flap elevation on the incidence of olfactory dysfunction. STUDY DESIGN Case series with chart review of patients undergoing endoscopic endonasal skull base surgery (2012-2014). SETTING Providence Saint John's Health Center and John Wayne Cancer Institute. SUBJECTS AND METHODS The incidences of postoperative epistaxis, hyposmia, and anosmia were analyzed using the Brief Smell Identification Test (B-SIT), which was completed in 110 of the 165 patients. RESULTS Seventy-eight patients required extended approaches. Bilateral nasoseptal rescue flaps were elevated in 144 patients (87.3%) and pedicled nasoseptal or middle turbinate flaps in 21 patients (12.7%). The neurovascular pedicles were preserved in all patients, and there were no episodes of postoperative arterial epistaxis. Normal olfaction was noted in 95 patients (86%), with new hyposmia noted in 5 patients (5.5%). Within the rescue flap cohort, new hyposmia occurred in 6.3% (P < .01) of patients, balanced by improvement of olfaction in 43% of patients with preoperative dysfunction (overall pre- and postoperative olfactory function: 85% vs 86%). Patients with pedicled nasoseptal flaps did not have new hyposmia, with a net improvement of olfaction (71% vs 86%, P = .07). No patients experienced new anosmia. There was no difference between flap type within either subgroup. CONCLUSIONS Superior olfactory strip preservation during elevation of reconstructive flaps preserves olfactory function and maintains adequate surgical exposure. In addition, rescue flaps have significantly diminished the rate of arterial postoperative epistaxis while maintaining the ability to harvest nasoseptal flaps for future reconstruction.
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Affiliation(s)
- Chester F Griffiths
- Pacific Neuroscience Institute & Pituitary Disorders Program, John Wayne Cancer Institute at Providence Saint John's Health Center, Santa Monica, California, USA
| | - Garni Barkhoudarian
- Pacific Neuroscience Institute & Pituitary Disorders Program, John Wayne Cancer Institute at Providence Saint John's Health Center, Santa Monica, California, USA
| | - Aaron Cutler
- Inland Neurosurgery Institute, Pomona, California, USA
| | - Huy T Duong
- University of California, Davis Medical School, Davis, California and The Kaiser Permanente Medical Group, Sacramento, California, USA
| | - Kian Karimi
- Pacific Eye and Ear Specialists, Los Angeles, California, USA
| | - Olivia Doyle
- Pacific Eye and Ear Specialists, Los Angeles, California, USA
| | - Ricardo Carrau
- Comprehensive Skull Base Surgery Program, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Daniel F Kelly
- Pacific Neuroscience Institute & Pituitary Disorders Program, John Wayne Cancer Institute at Providence Saint John's Health Center, Santa Monica, California, USA
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Fnais N, Maio SD, Edionwe S, Zeitouni A, Sirhan D, Valdes CJ, Tewfik MA. Hemi-transseptal Approach for Pituitary Surgery: A Follow-Up Study. J Neurol Surg B Skull Base 2017; 78:145-151. [PMID: 28321378 PMCID: PMC5357214 DOI: 10.1055/s-0036-1593816] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 09/13/2016] [Indexed: 10/20/2022] Open
Abstract
Objectives The hemi-transseptal (Hemi-T) approach was developed to overcome the potential drawbacks of the nasoseptal flap (NSF) in endoscopic endonasal transsphenoidal skull base surgery. In this study, we describe further refinements on the Hemi-T approach, and report long-term outcomes as compared with traditional methods of skull base reconstruction. Design A retrospective case-control study. Setting Montreal Neurological Institute and Jewish General Hospital, Montreal, Canada. Participants Patients who underwent endoscopic endonasal transsphenoidal approach to skull base pathology. Main Outcome Measures Operative time, CSF rhinorrhea, and postoperative nasal morbidity. Results A total of 105 patients underwent the Hemi-T approach versus 40 controls. Operative time was shorter using the Hemi-T technique (180.51 ± 56.9 vs. 202.9 ± 62 minutes; p = 0.048). The rates of nasal morbidity (septal perforation [5/102 vs. 6/37; p = 0.029] and mucosal adhesion [11/102 vs. 10/39 p = 0.027]), fascia lata harvest (21/100 vs. 18/39; p = 0.0028), and postoperative CSF leak rates (7/100 vs. 9/38; p = 0.006) were lower in the Hemi-T group. Conclusion Advantages of the Hemi-T approach over traditional exposure techniques include preservation of the nasal vascular pedicle, shorter operative time, reduced fascia lata harvest rates, and decreased nasal morbidity.
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Affiliation(s)
- Naif Fnais
- Department of Otolaryngology—Head and Neck Surgery, King Saud University, Riyadh, Saudi Arabia
- Department of Otolaryngology—Head and Neck Surgery, McGill University Health Centre, Montreal, Canada
| | | | - Susan Edionwe
- This author is currently working as Allergy and ENT Associate in Sugar Land, Texas, United States
| | - Anthony Zeitouni
- Department of Otolaryngology—Head and Neck Surgery, McGill University Health Centre, Montreal, Canada
| | - Denis Sirhan
- Department of Cerebrovascular and Skull Base Surgery, Montreal Neurological Institute, McGill University, Montreal, Canada
| | - Constanza J. Valdes
- Department of Otolaryngology—Head and Neck Surgery, Universidad de Chile, Santiago, Chile
| | - Marc A. Tewfik
- Department of Otolaryngology—Head and Neck Surgery, McGill University Health Centre, Montreal, Canada
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Wu P, Li Z, Liu C, Ouyang J, Zhong S. The posterior pedicled inferior turbinate–nasoseptal flap: a potential combined flap for skull base reconstruction. Surg Radiol Anat 2015; 38:187-94. [DOI: 10.1007/s00276-015-1516-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 06/29/2015] [Indexed: 12/01/2022]
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Zhang X, Wang EW, Wei H, Shi J, Snyderman CH, Gardner PA, Fernandez-Miranda JC. Anatomy of the posterior septal artery with surgical implications on the vascularized pedicled nasoseptal flap. Head Neck 2014; 37:1470-6. [DOI: 10.1002/hed.23775] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 04/16/2014] [Accepted: 05/16/2014] [Indexed: 11/12/2022] Open
Affiliation(s)
- Xian Zhang
- Department of Neurological Surgery; University of Pittsburgh Medical Center; Pittsburgh Pennsylvania
- Department of Neurosurgery; Nanfang Hospital, Southern Medical University; Guangzhou Guangdong People's Republic of China
| | - Eric W. Wang
- Department of Otolaryngology; University of Pittsburgh Medical Center; Pittsburgh Pennsylvania
| | - Hongquan Wei
- Department of Neurological Surgery; University of Pittsburgh Medical Center; Pittsburgh Pennsylvania
| | - Jin Shi
- Department of Neurosurgery; Nanfang Hospital, Southern Medical University; Guangzhou Guangdong People's Republic of China
| | - Carl H. Snyderman
- Department of Otolaryngology; University of Pittsburgh Medical Center; Pittsburgh Pennsylvania
| | - Paul A. Gardner
- Department of Neurological Surgery; University of Pittsburgh Medical Center; Pittsburgh Pennsylvania
| | - Juan C. Fernandez-Miranda
- Department of Neurological Surgery; University of Pittsburgh Medical Center; Pittsburgh Pennsylvania
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Griffiths CF, Cutler AR, Duong HT, Bardo G, Karimi K, Barkhoudarian G, Carrau R, Kelly DF. Avoidance of postoperative epistaxis and anosmia in endonasal endoscopic skull base surgery: a technical note. Acta Neurochir (Wien) 2014; 156:1393-401. [PMID: 24809531 DOI: 10.1007/s00701-014-2107-8] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 04/19/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Most endoscopic transsphenoidal approaches jeopardize the sphenopalatine artery and septal olfactory strip (SOS), increasing the risk of postoperative anosmia and epistaxis while precluding the ability to raise pedicled nasoseptal flaps (NSF). We describe a bilateral "rescue flap" technique that preserves the mucosa containing the nasal-septal vascular pedicles and the SOS. This approach can reduce the risk of postoperative complications, including epistaxis and anosmia. METHODS A retrospective analysis was conducted of all patients who underwent endoscopic transsphenoidal surgery with preservation of both sphenopalatine vascular pedicles and SOS. In a recent subset of patients, olfactory assessment was performed. RESULTS Of 174 consecutive operations performed in 161 patients, bilateral preservation of the sphenopalatine vascular pedicle and SOS was achieved in 139 (80 %) operations, including 31 (22 %) with prior transsphenoidal surgery. Of the remaining 35 operations, 18 had a planned formal NSF and 17 had prior surgery or extensive lesions precluding use of this technique. Of pituitary adenomas, RCCs or sellar arachnoid cysts, 118 (94 %) underwent this approach, including 91 % of patients who had prior surgery. Preoperative olfaction function was maintained in 97 % of patients that were tested. None of the patients had postoperative arterial epistaxis. CONCLUSION Preservation of bilateral sphenopalatine vascular pedicles and the SOS is feasible in over 90 % of patients undergoing endonasal endoscopic surgery for pituitary adenomas and RCCs. This approach, while not hindering exposure or limiting instrument maneuverability, preserves the nasoseptal vasculature for future NSF use if needed and appears to minimize the risks of postoperative arterial epistaxis and anosmia.
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Affiliation(s)
- Chester F Griffiths
- Saint Johns Medical Center, John Wayne Cancer Institute, 2200 Santa Monica Blvd, Santa Monica, CA, 90404, USA
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Cooper SE, Ramakrishnan VR. Direct cauterization of the nasal septal artery for epistaxis. Laryngoscope 2012; 122:738-40. [PMID: 22434678 DOI: 10.1002/lary.23225] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Emergency management of epistaxis may include the use of local pressure and vasoconstrictors, chemical or electric cautery, hemostatic agents, nasal packing, embolization, and surgical arterial ligation. There is no definitive protocol for the management of epistaxis, although various protocols have been proposed in the literature. As approaches to surgical ligation of the arterial supply of the nasal cavity have evolved from external carotid ligation to minimally invasive approaches, surgical management of epistaxis has become more effective than embolization and may be less risky. In the surgical management of epistaxis, arterial ligation immediately proximal to the bleeding site is preferred. We propose a simple variation of the endoscopic sphenopalatine artery ligation that may be used to manage epistaxis arising from the nasal septum and floor.
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Affiliation(s)
- Sarah E Cooper
- Department of Otolaryngology, University of Colorado, Aurora, Colorado 80045, USA
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Abstract
One of the major challenges of cranial base surgery is reconstruction of basal dural defects. Ineffective reconstruction may result in potentially life-threatening complications such as cerebrospinal fluid leak, meningitis, and tension pneumocephalus. Goals of reconstructive procedures are to repair the dural defect and to separate intracranial contents from bacteria-laden secretion of the mouth, nose, and sinus. Different reconstructive techniques have been reported. Multiple factors may influence the surgical choice of reconstructive technique and its outcome. Regional pedicled flap and vascular free flaps represent the best reconstructive options because vascularized tissues promote fast and complete healing. A variety of endoscopic pedicled mucosal flaps within the nasal cavity have also been described. The different reconstruction techniques are described and discussed in terms of indications, advantages, and drawbacks.
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Abstract
Endoscopic sphenoidotomy is a common surgical procedure that often accompanies routine sinus surgery. Safe completion of a sphenoidotomy depends on a thorough understanding of the surrounding anatomy, reviewing preoperative imaging, and maintaining intraoperative orientation. Intraoperative complications include local hemorrhage, catastrophic hemorrhage caused by internal carotid injury, optic nerve injury, and CSF leak. Postoperative complications tend to be less severe and include postoperative stenosis and mucocele formation. Regarding surgery of the sphenoid sinuses, the best management of complications truly is prevention, making pre- and intraoperative vigilance vital to a successful outcome.
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Kassam AB, Thomas A, Carrau RL, Snyderman CH, Vescan A, Prevedello D, Mintz A, Gardner P. Endoscopic Reconstruction of the Cranial Base Using a Pedicled Nasoseptal Flap. Oper Neurosurg (Hagerstown) 2008; 63:ONS44-52; discussion ONS52-3. [PMID: 18728603 DOI: 10.1227/01.neu.0000297074.13423.f5] [Citation(s) in RCA: 291] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Objective:
Reconstruction of the cranial base using vascularized tissue promotes rapid and complete healing, thus avoiding complications caused by persistent communication between the cranial cavity and the sinonasal tract. The Hadad-Bassagasteguy flap (HBF), a neurovascular pedicled flap of the nasal septum mucoperiosteum and mucoperichondrium based on the nasoseptal artery, seems to be advantageous for the reconstruction of the cranial base after endonasal cranial base surgery
Methods:
We performed a retrospective review of patients who underwent endonasal cranial base surgery at the University of Pittsburgh Medical Center from January 30, 2006 to January 30, 2007, identifying patients who experienced reconstruction with a vascularized septal mucosal flap (HBF). We analyzed the demographic data, pathological characteristics, site and extent of resection, use of cerebrospinal fluid (CSF) diversion techniques, and outcome.
Results:
Seventy-five patients who underwent endonasal cranial base endoscopic surgery received repair with the HBF. In this population, we encountered eight postoperative CSF leaks (10.66%), all in patients who required intra-arachnoidal dissection. When we correct the statistical analysis to include only patients with intra-arachnoidal lesions, the postoperative CSF leak rate is 14.5% (eight of 55 patients). It is notable that six CSF (33%) leaks occurred in our first 25 repairs, whereas we encountered only two postoperative leaks (4%) in the last 50 patients. The corrected CSF leak rate, considering only intra-arachnoidal lesions, was two (5.4%) of 37 patients. This improvement in the CSF leak rate reflects our growing experience and comfort with this reconstructive technique. All of our failures could be matched to a specific technical mistake In addition, we modified the flap-harvesting technique to allow for staged procedures and the removal of caudal lesions. These special circumstances require storage of the flap in the antrum during the removal of caudal lesions, and suturing of the flap in its original position for staged procedures. One patient experienced a posterior nose bleed from the posterior nasal artery. This was controlled with bipolar electrocautery, thereby preserving the flap blood supply. We encountered no infectious or wound complications in this series of patients. The donor site accumulates crusting, which requires debridement until mucosalization is complete; this usually occurs 6 to 12 weeks after surgery.
Conclusion:
The HBF is a versatile and reliable reconstructive technique for repairing defects of the anterior, middle, clival, and parasellar cranial base. Its use has resulted in a significant decrease in our incidence of CSF leaks after endonasal cranial base surgery. Attention to technical details is of paramount importance to achieve the best outcomes.
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Affiliation(s)
- Amin B. Kassam
- Departments of Neurological Surgery and Otolaryngology, University of Pittsburgh and University of Pittsburgh Medical Center, Presbyterian University Hospital, Pittsburgh, Pennsylvania
| | - Ajith Thomas
- Department of Neurological Surgery, University of Pittsburgh and University of Pittsburgh Medical Center, Presbyterian University Hospital, Pittsburgh, Pennsylvania
| | - Ricardo L. Carrau
- Departments of Neurological Surgery and Otolaryngology, University of Pittsburgh and University of Pittsburgh Medical Center, Presbyterian University Hospital, Pittsburgh, Pennsylvania
| | - Carl H. Snyderman
- Departments of Neurological Surgery and Otolaryngology, University of Pittsburgh and University of Pittsburgh Medical Center, Presbyterian University Hospital, Pittsburgh, Pennsylvania
| | - Allan Vescan
- Department of Neurological Surgery, University of Pittsburgh and University of Pittsburgh Medical Center, Presbyterian University Hospital, Pittsburgh, Pennsylvania
| | - Daniel Prevedello
- Department of Neurological Surgery, University of Pittsburgh and University of Pittsburgh Medical Center, Presbyterian University Hospital, Pittsburgh, Pennsylvania
| | - Arlan Mintz
- Department of Neurological Surgery, University of Pittsburgh and University of Pittsburgh Medical Center, Presbyterian University Hospital, Pittsburgh, Pennsylvania
| | - Paul Gardner
- Department of Neurological Surgery, University of Pittsburgh and University of Pittsburgh Medical Center, Presbyterian University Hospital, Pittsburgh, Pennsylvania
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Hadad G, Bassagasteguy L, Carrau RL, Mataza JC, Kassam A, Snyderman CH, Mintz A. A novel reconstructive technique after endoscopic expanded endonasal approaches: vascular pedicle nasoseptal flap. Laryngoscope 2006; 116:1882-6. [PMID: 17003708 DOI: 10.1097/01.mlg.0000234933.37779.e4] [Citation(s) in RCA: 1212] [Impact Index Per Article: 67.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND In patients with large dural defects of the anterior and ventral skull base after endonasal skull base surgery, there is a significant risk of a postoperative cerebrospinal fluid leak after reconstruction. Reconstruction with vascularized tissue is desirable to facilitate rapid healing, especially in irradiated patients. METHODS We developed a neurovascular pedicled flap of the nasal septum mucoperiosteum and mucoperichondrium based on the nasoseptal artery, a branch of the posterior septal artery (Hadad-Bassagasteguy flap [HBF]). A retrospective review of patients undergoing endonasal skull base surgery at the University of Rosario, Argentina, and the University of Pittsburgh Medical Center was performed to identify patients who were reconstructed with a vascularized septal mucosal flap. RESULTS Forty-three patients undergoing endonasal cranial base surgery were repaired with the septal mucosal flap. Two patients with postoperative cerebrospinal fluid leaks (5%) were successfully treated with focal fat grafts. We encountered no infectious or wound complications in this series of patients. One patient experienced a posterior nose bleed from the posterior nasal artery. This was controlled with electrocautery and the flap blood supply was preserved. CONCLUSION The HBF is a versatile and reliable reconstructive technique for defects of the anterior, middle, clival, and parasellar skull base. Its use has resulted in a sharp decrease in the incidence of postoperative cerebrospinal fluid leaks after endonasal skull base surgery and is recommended for the reconstruction of large dural defects and when postoperative radiation therapy is anticipated.
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Affiliation(s)
- Gustavo Hadad
- Department of Otolaryngology-Head & Neck Surgery, Medical School of Ciudad de Rosario, Provincia de Santa Fe, Republica Argentina
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Chiu T, Dunn JS. An anatomical study of the arteries of the anterior nasal septum. Otolaryngol Head Neck Surg 2006; 134:33-6. [PMID: 16399177 DOI: 10.1016/j.otohns.2005.09.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The anterior nasal septum is a clinically important area, yet anatomical descriptions of its arterial pattern are hitherto incomplete. This study aimed to test the hypothesis that the arteries of the anterior nasal septum form a fine random network of vessels. STUDY DESIGN The arterial pattern of the nasal septum was traced by microdissection of 12 cadaveric septa (24 sides). SETTING Each septum was microdissected with a Watson-Barnet dissecting microscope. Specimens were photographed and the vascular patterns were analyzed. RESULTS The anterior septum has a consistent large arterial anastomotic triangle receiving major contributions from sphenopalatine, anterior ethmoidal, and superior labial arteries. CONCLUSION Systematic microdissections clearly demonstrate that the arteries of the anterior septum do not form a random network. Instead, they form a consistent arterial anastomotic triangle consisting of large, thin vessels. SIGNIFICANCE The study provides background material useful to the understanding of nasal physiology and pathology including epistaxis.
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Affiliation(s)
- Tor Chiu
- Department of Surgery, Plastic Reconstructive Surgery, The Chinese University of Hong Kong, Clinical Sciences Building, Prince of Wales Hospital, Hong Kong ROC.
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Babin E, Moreau S, de Rugy MG, Delmas P, Valdazo A, Bequignon A. Anatomic variations of the arteries of the nasal fossa. Otolaryngol Head Neck Surg 2003; 128:236-9. [PMID: 12601320 DOI: 10.1067/mhn.2003.84] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study was performed for knowledge about the vascular supply of the nasal fossa and a description of the site of division and number of branches of the sphenopalatine artery. STUDY DESIGN This study was performed on 10 fresh nonembalmed cadavers. Anatomic variations of nasal fossa arteries were studied. METHODS First, 10 cephalic anatomic preparations were injected with red color latex into the right and left carotid arteries. Then, these specimens were sagittaly cut to dissect the sphenopalatine artery. Twenty vascularization cases were studied for the external branch of the sphenopalatine artery, and 10 cases were studied for the internal branch. RESULTS The principal observations were: 1. the sphenopalatine artery division is 18 times in the infratemporal fossa and twice in the nasal fossa; 2. the nasopalatine artery supplies blood to the lower part of the septum and its anterosuperior area; and 3. the vascularization of the external wall is via the sphenopalatine artery through the arteries of the meatus and conchae. CONCLUSION This study defines the vascular territories of the nasal fossa arteries and includes photographs of dissections.
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Affiliation(s)
- Emmanuel Babin
- Department of Oto-Rhino-Laryngologie et Chirugie Cervico-Faciale, France
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