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Pop SS, Tiple C, Stamate MC, Chirila M. Endoscopic Sphenopalatine Artery Cauterization in the Management of Recurrent Posterior Epistaxis. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1128. [PMID: 37374332 DOI: 10.3390/medicina59061128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 06/06/2023] [Accepted: 06/10/2023] [Indexed: 06/29/2023]
Abstract
Background and Objectives: Endoscopic sphenopalatine artery cauterization (ESPAC) has become a reliable and effective surgical procedure for managing posterior epistaxis. The objectives of our study were to evaluate the effectiveness of ESPAC in the management of posterior epistaxis and the possible factors that lead to the failure of the procedure. Materials and Methods: We performed a retrospective analysis of all patients who underwent ESPAC between 2018 and 2022. We retrospectively reviewed the demographic data, patients' co-morbidities, medical treatment conditions, whether other surgical procedures were performed in addition to the ESPAC, and the success rate of ESPAC. Results: 28 patients were included in our study. After ESPAC, epistaxis was successfully managed in 25 patients (89.28%). Of all patients undergoing ESPAC, three (10.7%) presented re-bleeding. In two patients, we performed an endoscopic revision surgery with re-cauterization of the sphenopalatine foramen area, together with anterior and posterior ethmoidectomy, followed by fat occlusion/obliteration of these sinuses. In one patient, fat obliteration of the anterior and posterior ethmoid was also unsuccessful, and we performed an external carotid artery ligation at the level of the neck with no recurrence afterwards. Conclusions: Endoscopic cauterization of the sphenopalatine artery remains a safe, effective, and reliable surgical procedure in the management of recurrent posterior epistaxis. The use of anticoagulant drugs and the association of hypertension and other heart and liver diseases do not materialize as factors influencing surgical failure.
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Affiliation(s)
- Sever Septimiu Pop
- ENT Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
- ENT Clinic, Emergency County Hospital, 400006 Cluj-Napoca, Romania
| | - Cristina Tiple
- ENT Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
- ENT Clinic, Emergency County Hospital, 400006 Cluj-Napoca, Romania
| | - Mirela Cristina Stamate
- ENT Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
- ENT Clinic, Emergency County Hospital, 400006 Cluj-Napoca, Romania
| | - Magdalena Chirila
- ENT Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
- ENT Clinic, Emergency County Hospital, 400006 Cluj-Napoca, Romania
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Ramachandran SN, Retnathankom A, Rege I, Reddy KT. Endovascular management of a sphenopalatine artery pseudoaneurysm: a rare cause of delayed intractable epistaxis following endoscopic transsphenoidal pituitary surgery. BMJ Case Rep 2023; 16:e253998. [PMID: 37130637 PMCID: PMC10163417 DOI: 10.1136/bcr-2022-253998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
Vascular injuries during pituitary surgery are feared as they can lead to serious disability and can be life threatening. We are describing a case of severe intractable epistaxis following endoscopic transnasal transsphenoidal surgery for pituitary tumour due to a sphenopalatine artery pseudoaneurysm which was successfully managed using endovascular embolisation techniques. Very few cases of sphenopalatine artery pseudoaneurysm following endoscopic nasal surgery have been described. A middle aged male patient with a pituitary macroadenoma underwent endoscopic transsphenoidal pituitary surgery and returned to us after 3 days of discharge with severe epistaxis. Digital subtraction angiography showed contrast leakage and left sphenopalatine artery pseudoaneurysm. Glue embolisation of the distal sphenopalatine branches and pseudoaneurysm was done. Good occlusion of pseudoaneurysm was seen. Such a diagnosis for epistaxis following endoscopic transnasal surgery should be borne in mind, so prompt treatment can be planned to avoid life threatening complications.
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Affiliation(s)
| | | | - Ishant Rege
- Department of Neurosurgery, Amrita Institute of Medical Sciences, Cochin, India
| | - Krishna Tej Reddy
- Department of Neurosurgery, Amrita Institute of Medical Sciences, Cochin, India
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Endoscopic sphenopalatine foramen cauterization is an effective treatment modification of endoscopic sphenopalatine artery ligation for intractable posterior epistaxis. Eur Arch Otorhinolaryngol 2020; 277:2463-2467. [DOI: 10.1007/s00405-020-06005-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 04/22/2020] [Indexed: 11/25/2022]
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D'Oto AD, Cox S, Svider P, Rangarajan S, Sheyn A. Safety and efficacy of sphenopalatine artery ligation in recalcitrant pediatric epistaxis. Int J Pediatr Otorhinolaryngol 2019; 123:128-131. [PMID: 31102966 DOI: 10.1016/j.ijporl.2019.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 05/07/2019] [Accepted: 05/08/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Epistaxis is a common cause for emergency department visits for both children and adults. In particular, posterior bleeds can be difficult to identify and treat. In adults, endoscopic sphenopalatine artery (SPA) ligation has been shown to be safe, cost-effective, and curative. Conversely, very few studies have delved into the safety and efficacy of SPA ligation in children. This study aims to evaluate the feasibility of SPA ligation for treatment of recalcitrant epistaxis in children. METHODS A retrospective analysis of outcomes in pediatric patients who underwent SPA ligation at a tertiary academic center was performed. Patients with coagulopathies or other underlying conditions were excluded from the study. RESULTS Data obtained from 5 patients demonstrated 60% of the population were female, with ages ranging from 2 to 13 years. 7 SPA ligations were performed among the 5 patients, with 3 undergoing unilateral SPA ligation only. The remaining 4 underwent contralateral SPA ligation subsequently. No postoperative complications were observed, and all patients experienced resolution of significant epistaxis. CONCLUSION Although additional studies are necessary to further support our findings, SPA ligation in the pediatric population appears to be a safe and effective treatment to control persistent posterior bleeds.
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Affiliation(s)
- Alexandra D D'Oto
- Department of Otolaryngology - University of Tennessee Health Science Center, Memphis, TN, USA.
| | - Steven Cox
- Department of Otolaryngology - University of Tennessee Health Science Center, Memphis, TN, USA
| | - Peter Svider
- Department of Otolaryngology-Head and Neck Surgery - Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Sanjeet Rangarajan
- Department of Otolaryngology - University of Tennessee Health Science Center, Memphis, TN, USA
| | - Anthony Sheyn
- Department of Otolaryngology - University of Tennessee Health Science Center, Memphis, TN, USA; Department of Otolaryngology - St. Jude Children's Research Hospital, Memphis, TN, USA
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The distribution of bleeding sites in idiopathic hidden arterial epistaxis. The Journal of Laryngology & Otology 2019; 133:309-312. [PMID: 30929656 DOI: 10.1017/s0022215119000562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To determine the frequency distribution of bleeding sites in idiopathic hidden arterial epistaxis. METHODS In this retrospective cohort study, 107 patients with hidden arterial epistaxis were endoscopically examined for sites of bleeding. RESULTS All sites of hidden arterial epistaxis were identified by endoscopic examination. Bleeding sites were identified at initial surgery in 103 patients and during the second surgery in 4. The bleeding sites included: the olfactory cleft region in 47 patients, the inferior meatus region in 29, the middle meatus region in 11, multiple bleeding sites (olfactory cleft and anterior septum) in 3, the anterior roof of the nasal cavity in 4, the nasal floor in 11 and the nasopharynx in 2. The bleeding points showed a white or red volcano-like bump in 75 patients, isolated prominent telangiectasia in 21 and mucosal ulceration in 11. CONCLUSION Common sites of hidden arterial epistaxis include the olfactory cleft, inferior meatus and middle meatus. However, there should be awareness of some uncommon bleeding sites (including the anterior roof of the nasal cavity, the nasal floor and the nasopharynx) and of multiple bleeding sites.
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Endoscopic sphenopalatine artery ligation for acute idiopathic epistaxis. Do anatomical variation and a limited evidence base raise questions regarding its place in management? The Journal of Laryngology & Otology 2017; 131:290-297. [PMID: 28179040 DOI: 10.1017/s0022215117000214] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Endoscopic sphenopalatine artery ligation is widely accepted as effective and safe for acute spontaneous epistaxis that is unresponsive to conservative management. As with many new procedures, it has been progressively adopted as common practice, despite a limited evidence base for its efficacy. Early reviews called for comparative trials to support its adoption, but subsequent literature largely consists of case series and narrative reviews. These have attempted to derive an algorithm to establish its place in management, but consensus is still lacking. Intuitively, although there are theoretical objections, an operation regarded as relatively simple, fast and safe hardly seems to demand high-level evidence of efficacy. Rhinologists may be influenced by years of personal experience and success with the technique. However, estimates of the effect size and the added contribution to traditional surgical management are lacking. If the procedure could be shown to dramatically influence outcome, it should be standard practice and indispensable for all patients requiring operative intervention. OBJECTIVES This paper systematically examined the literature, appraising the anatomical basis for such an approach and evidence for its efficacy. It questions whether any units unable to consistently offer endoscopic sphenopalatine artery ligation should be undertaking surgical management of acute epistaxis.
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Endoscopic Resection of Pterygopalatine Fossa and Infratemporal Fossa Malignancies. Otolaryngol Clin North Am 2017; 50:301-313. [PMID: 28162242 DOI: 10.1016/j.otc.2016.12.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The endoscopic resection of pterygopalatine and infratemporal fossa malignancies allows excellent visualization and manipulation of tissues in an anatomically complex area compared with open approaches. With less approach morbidity, endoscopic endonasal surgery allows an easier recovery and earlier transition to adjuvant radiotherapy. The endoscopic approach is minimal access but rarely minimally invasive. Surgeons should not hesitate to gain wide surgical exposure of the pterygopalatine, infratemporal fossa, and petrocavernous carotid artery to ensure comfortable maneuverability and easy visualization of the tumor and its normal tissue margins. This method maximizes the chances of complete resection and effective postoperative surveillance.
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Sylvester MJ, Chung SY, Guinand LA, Govindan A, Baredes S, Eloy JA. Arterial ligation versus embolization in epistaxis management: Counterintuitive national trends. Laryngoscope 2016; 127:1017-1020. [DOI: 10.1002/lary.26452] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 10/31/2016] [Accepted: 11/10/2016] [Indexed: 11/08/2022]
Affiliation(s)
- Michael J. Sylvester
- Department of Otolaryngology–Head and Neck SurgeryRutgers New Jersey Medical SchoolNewark New Jersey U.S.A
| | - Sei Y. Chung
- Department of Otolaryngology–Head and Neck SurgeryRutgers New Jersey Medical SchoolNewark New Jersey U.S.A
| | - Luis A. Guinand
- Department of Otolaryngology–Head and Neck SurgeryRutgers New Jersey Medical SchoolNewark New Jersey U.S.A
| | - Aparna Govindan
- Department of Otolaryngology–Head and Neck SurgeryRutgers New Jersey Medical SchoolNewark New Jersey U.S.A
| | - Soly Baredes
- Department of Otolaryngology–Head and Neck SurgeryRutgers New Jersey Medical SchoolNewark New Jersey U.S.A
- Center for Skull Base and Pituitary Surgery, Neurological Institute of New JerseyRutgers New Jersey Medical SchoolNewark New Jersey U.S.A
| | - Jean Anderson Eloy
- Department of Otolaryngology–Head and Neck SurgeryRutgers New Jersey Medical SchoolNewark New Jersey U.S.A
- Center for Skull Base and Pituitary Surgery, Neurological Institute of New JerseyRutgers New Jersey Medical SchoolNewark New Jersey U.S.A
- Department of Neurological SurgeryRutgers New Jersey Medical SchoolNewark New Jersey U.S.A
- Department of Ophthalmology and Visual ScienceRutgers New Jersey Medical SchoolNewark New Jersey U.S.A
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MacArthur FJD, McGarry GW. The arterial supply of the nasal cavity. Eur Arch Otorhinolaryngol 2016; 274:809-815. [PMID: 27568352 DOI: 10.1007/s00405-016-4281-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 08/22/2016] [Indexed: 11/27/2022]
Abstract
With the development of endonasal flaps, an understanding of the arterial anatomy of the nasal cavity has become increasingly important for clinicians. Despite this, there is a lack of current, accurate overviews in the literature. We have used both endoscopic and gross dissection of six fresh frozen cadaveric heads, alongside a literature review, to produce a comprehensive description of the anatomy. Four heads had their arterial systems injected with red latex. Three injected and two uninjected heads were dissected endoscopically, to provide a total of seven sides. The fourth injected head was hemisected for gross examination. The arterial systems were dissected and examined. The posterior septal artery was found to enter the nasal cavity from the sphenopalatine foramen in five sides. It bifurcated on the sphenoid rostrum in seven sides with a bifurcation lateral to the sphenoid ostium occurring in five sides and a medial bifurcation in two sides. The posterior septal artery supplied Kiesselbach's plexus on the nasal septum along with the greater palatine artery and septal branches of the superior labial and anterior ethmoidal arteries. The posterior lateral nasal artery arose from the sphenopalatine foramen in five sides to supply the lateral wall. The lateral wall branch of the anterior ethmoidal and the anterior lateral nasal artery anastomosed at the head of the inferior turbinate. These findings were mostly consistent with the current literature. We have produced a detailed and up-to-date description and diagram of the arterial supply to the nasal cavity, which may be of use to clinicians, anatomists and students.
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Affiliation(s)
- Francisco J D MacArthur
- Department of Anatomy, School of Biomedical Sciences, The University of Edinburgh, Edinburgh, UK.
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Weber RK, Hosemann W. Comprehensive review on endonasal endoscopic sinus surgery. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2015; 14:Doc08. [PMID: 26770282 PMCID: PMC4702057 DOI: 10.3205/cto000123] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Endonasal endoscopic sinus surgery is the standard procedure for surgery of most paranasal sinus diseases. Appropriate frame conditions provided, the respective procedures are safe and successful. These prerequisites encompass appropriate technical equipment, anatomical oriented surgical technique, proper patient selection, and individually adapted extent of surgery. The range of endonasal sinus operations has dramatically increased during the last 20 years and reaches from partial uncinectomy to pansinus surgery with extended surgery of the frontal (Draf type III), maxillary (grade 3-4, medial maxillectomy, prelacrimal approach) and sphenoid sinus. In addition there are operations outside and beyond the paranasal sinuses. The development of surgical technique is still constantly evolving. This article gives a comprehensive review on the most recent state of the art in endoscopic sinus surgery according to the literature with the following aspects: principles and fundamentals, surgical techniques, indications, outcome, postoperative care, nasal packing and stents, technical equipment.
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Affiliation(s)
- Rainer K. Weber
- Division of Paranasal Sinus and Skull Base Surgery, Traumatology, Department of Otorhinolaryngology, Municipal Hospital of Karlsruhe, Germany
- I-Sinus International Sinus Institute, Karlsruhe, Germany
| | - Werner Hosemann
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Greifswald, Germany
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Changing Trends in the Management of Epistaxis. Int J Otolaryngol 2015; 2015:263987. [PMID: 26351457 PMCID: PMC4553192 DOI: 10.1155/2015/263987] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 06/20/2015] [Accepted: 06/22/2015] [Indexed: 11/18/2022] Open
Abstract
Epistaxis is a very common complaint seen by many types of physicians including otolaryngologists, family physicians, and others. Management of epistaxis is often challenging and requires many types of intervention. The following review describes the different types of past and current treatment modalities including cautery, nasal packing, maxillary artery ligation, anterior artery ligation, and sphenopalatine artery ligation. The paper also proposes an algorithm for managing such cases.
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Sphenopalatine foramen: endoscopic approach with bony landmarks. The Journal of Laryngology & Otology 2015; 129 Suppl 3:S47-52. [PMID: 25816928 DOI: 10.1017/s0022215115000766] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To establish whether nasal bony landmarks on computed tomography could be utilised reliably in endoscopic approaches to the sphenopalatine foramen. METHODS A prospective analysis of 102 consecutive helical computed tomography scans of the paranasal sinuses was carried out by 2 senior ENT surgeons. Distances from the sphenopalatine foramen to endoscopically palpable bony landmarks were measured. RESULTS There were a total of 102 patients (45 females and 57 males), with a mean age of 62 years. The mean distance from the posterior fontanelle to the sphenopalatine foramen was 14.1 mm (standard deviation = 2.13). The average vertical distance of the sphenopalatine foramen opening from the bony attachment of the inferior turbinate was 14.13 mm. There were no statistically significant differences between any of these measurements (foramen width p-value = 0.714, distance from fontanelle p-value = 0.43 and distance from inferior turbinate p-value = 0.48). CONCLUSION Determination of reliable bony landmarks is clinically useful in endoscopic surgery and can aid identification of the sphenopalatine foramen. The inferior turbinate concha and posterior fontanelle may be used as reliable computed tomography landmarks for endoscopic approaches to the sphenopalatine foramen.
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Comparison of lateral microsurgical preauricular and anterior endoscopic approaches to the jugular foramen. The Journal of Laryngology & Otology 2015; 129 Suppl 2:S12-20. [DOI: 10.1017/s0022215114002321] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractIntroduction:This project compares access to the anterolateral part of the jugular foramen provided by the lateral microsurgical preauricular and the anterior endoscopic approaches, and defines the important landmarks involved in each approach.Study Design:Cadaveric study.Results:The endoscopic transnasal/transmaxillary transpterygoid corridor provides a less invasive route for selected lesions in the jugular foramen than the traditional open route through the preauricular subtemporal infratemporal fossa approach. However, the anterior endoscopic approach provides a smaller channel to the jugular foramen than the preauricular approach.Conclusions:The anterior endoscopic approach to the anterolateral part of the jugular foramen is a useful alternative to the lateral microsurgical preauricular approach in carefully selected cases. The vaginal process of the tympanic part of the temporal bone provides a valuable landmark to aid in accessing the jugular foramen in both procedures and can be drilled to open the foramen in the preauricular approach.
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Wang L, Gun R, Youssef A, Carrau RL, Prevedello DM, Otto BA, Ditzel L. Anatomical study of critical features on the posterior wall of the maxillary sinus: clinical implications. Laryngoscope 2014; 124:2451-5. [PMID: 24622922 DOI: 10.1002/lary.24676] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 03/04/2014] [Accepted: 03/11/2014] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS Endonasal approaches to the pterygopalatine fossa for epistaxis or as part of a transpterygoid approach have been popularized somewhat by the ability to control the terminal branches of the maxillary artery (MA). Surgical landmarks are useful to identify these arteries. Therefore, identification of surface features on the posterior wall of the antrum that reflect the position of deeper structures within the pterygopalatine fossa would help predict anatomical position and orientation. STUDY DESIGN Describe the incidence of identifiable markings on the posterior wall of the maxillary sinus and ascertain their nature. METHODS An anatomical study of 18 cadaveric specimens noting and recording the presence, location, and number of prominences on the posterior wall of the antrum. After removing the bony wall, structure in the pterygopalatine fossa corresponding to the surface markings was noted. RESULTS Two prominences were identified. Prominence (P)1 extended from the upper part of the posterior wall of the maxillary sinus to the inferior orbit and corresponded to the infraorbital nerve. P2 was located at the middle part of the posterior wall, below P1, and corresponded to the MA. P2 was located medial to a vertical "drop line" where P1 connected to the posterior wall. P1 and P2 were found in 41.7% and 22.2%, respectively, of the specimens. CONCLUSIONS This study defines features on the maxillary sinus posterior wall from an endoscopic perspective. These landmarks may be useful to identify the MA and its branches during surgery within the pterygopalatine fossa. LEVEL OF EVIDENCE N/A.
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Affiliation(s)
- Liang Wang
- Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio, U.S.A; Department of Otolaryngology-Head and Neck Surgery, First Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan, 450052, China
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Bryant L, Goodmurphy CW, Han JK. Endoscopic and Three-Dimensional Radiographic Imaging of the Pterygopalatine and Infratemporal Fossae. Ann Otol Rhinol Laryngol 2014; 123:111-6. [DOI: 10.1177/0003489414523707] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: We sought to define the surgical endoscopic anatomy of the pterygopalatine fossa (PPF) and infratemporal fossa (ITF) through endoscopic cadaver dissections and radiographic imaging analysis. Methods: Eleven fresh cadavers were submitted to computed tomography (CT) and endoscopic dissection. We used 3-dimensional (3-D) CT reconstruction and endoscopic video imaging for analysis of the bony and soft tissue landmarks. One fixed cadaver head was grossly dissected to confirm the endoscopic anatomic findings. Results: The CT and 3-D CT reconstruction measurements between the pterygoid canal and the foramen rotundum averaged 4.36 mm and 5.09 mm, respectively. An osseous ridge (pterygoid ridge) was identified on the anterior face of the pterygoid process as a novel identifiable anatomic landmark in all of the specimens. The average length of the pterygoid ridge on 3-D CT reconstruction was 7.84 mm. The internal maxillary artery entered the PPF posteromedial to the temporalis tendon and anterolateral to the lateral pterygoid muscle. The average distance from the anterior edge of the lateral pterygoid plate to the foramen ovale was 17.1 mm. Conclusions: The pterygoid ridge is a novel and reliable osseous landmark that could assist surgeons during endoscopic surgery on the PPF and ITF. The neurovascular and muscular anatomic relationships were characterized for both the PPF and the ITF.
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Affiliation(s)
- Lucas Bryant
- Departments of Otolaryngology–Head and Neck Surgery (Bryant, Han), Eastern Virginia Medical School, Norfolk, Virginia
- Anatomy and Pathology (Goodmurphy), Eastern Virginia Medical School, Norfolk, Virginia
| | - Craig W. Goodmurphy
- Departments of Otolaryngology–Head and Neck Surgery (Bryant, Han), Eastern Virginia Medical School, Norfolk, Virginia
- Anatomy and Pathology (Goodmurphy), Eastern Virginia Medical School, Norfolk, Virginia
| | - Joseph K. Han
- Departments of Otolaryngology–Head and Neck Surgery (Bryant, Han), Eastern Virginia Medical School, Norfolk, Virginia
- Anatomy and Pathology (Goodmurphy), Eastern Virginia Medical School, Norfolk, Virginia
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Alherabi A, Marglani O, Herzallah IR, Shaibah H, Alaidarous T, Alkaff H, Farooq M, Hassan H, Alharbi F, Al-Qahtani K. Endoscopic localization of the sphenopalatine foramen: do measurements matter? Eur Arch Otorhinolaryngol 2014; 271:2455-60. [PMID: 24414615 DOI: 10.1007/s00405-014-2881-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Accepted: 01/03/2014] [Indexed: 11/28/2022]
Abstract
The objective of this study was to evaluate different methods and measurements for localization of the sphenopalatine foramen (SPF) during endoscopic transnasal exposure. The study design consisted of descriptive anatomical study and the setting was in Microsurgical Cadaver Dissection Lab. Sixteen lateral nasal walls were dissected endoscopically to identify and localize the SPF. Multiple measurements were obtained from nasal sill (NS) to SPF, ethmoid crest (EC), and other related landmarks. The results showed that EC was identified in all sides with different degrees of projection. SPF extended below the inferior edge of EC, i.e., lying both in the superior and middle meatus, in 12 sides (75 %), while it was laying only in the superior meatus in 4 sides (25 %). An accessory foramen was identified in 3 sides (18.7 %), all of which were located in middle meatus. The distance from NS to SPF ranged widely from 55 to 76 mm (mean ± SD 64.4 ± 6 mm). The average angle of elevation formed between SPF to NS and nasal floor was 11.4° (range 11-12°). Although many previous studies have reported measurements to SPF, we do not believe these measurements are of practical help due to the wide range of measurements and the lack of standard reference points. The main constant landmark for SPF remains the EC. Since SPF frequently extends below EC, the mucoperiosteal flap should be extended below the inferior edge of this crest to avoid missing the middle meatal part of SPF or any accessory foramina.
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Affiliation(s)
- Ameen Alherabi
- Department of Otolaryngology-Head and Neck Surgery, Umm Al-Qura University, Makkah, P.O.Box 41405, Jeddah, 21521, Saudi Arabia,
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Gras-Cabrerizo JR, Ademá-Alcover JM, Gras-Albert JR, Kolanczak K, Montserrat-Gili JR, Mirapeix-Lucas R, Del Campo FS, Massegur-Solench H. Anatomical and surgical study of the sphenopalatine artery branches. Eur Arch Otorhinolaryngol 2013; 271:1947-51. [PMID: 24253386 DOI: 10.1007/s00405-013-2825-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 11/08/2013] [Indexed: 11/28/2022]
Abstract
The sphenopalatine artery gives off two main branches: the posterior lateral nasal branch and the posterior septal branch. From 2007 to 2012 17 patients were treated with cauterization and/or ligature of the sphenopalatine artery with endonasal endoscopic approach. 90 nasal dissections were performed in 45 adult cadaveric heads. We evaluated the number of branches emerging from the sphenopalatine foramen and the presence of an accessory foramen. In the surgery group, we observed a single trunk in 76% of the patients (13/17) and a double trunk in 24% (4/17). We found an accessory foramen in four cases. We obtained a successful result in bleeding control in 88% of the cases. In the cadaver dissection group, 55 nasal cavities had a single arterial trunk (61%), 30 had 2 arterial trunks (33%) and in only 5 nasal fossae we observed 3 arterial trunks (6%). We were able to dissect four accessory foramina. We suggest that in most cases only one or two branches are found in the sphenopalatine foramen.
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Affiliation(s)
- Juan R Gras-Cabrerizo
- Department of Otolaryngology/Head and Neck Surgery, Hospital de La Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain,
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Lakhani R, Syed I, Qureishi A, Bleach N. The Wexham Criteria: defining severe epistaxis to select patients requiring sphenopalatine artery ligation. Eur Arch Otorhinolaryngol 2012; 270:2039-43. [PMID: 23254397 DOI: 10.1007/s00405-012-2318-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Accepted: 12/06/2012] [Indexed: 10/27/2022]
Abstract
This study aims to provide guidance regarding patient selection and timing of intervention with sphenopalatine artery (SPA) ligation by defining 'severe epistaxis'. An analysis of all patients undergoing SPA ligation (January 2002-2010) was performed. SPA ligation was deemed necessary if at least one of the four identified criteria was fulfilled. The same analysis was also performed on all patients admitted with epistaxis who did not undergo SPA ligation over a 6-month period. All 27 patients who underwent SPA ligation met at least one of the criteria selected. Uncontrolled epistaxis (21/27) was fulfilled most often. In comparison, only 4/71 patients admitted with epistaxis who did not undergo SPA ligation fulfilled any single criterion. All criteria were satisfied in a significantly higher number of cases in the SPA group (p < 0.001) The criteria studied proved helpful in identifying patients admitted to hospital with epistaxis who had failed conservative measures.
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Affiliation(s)
- Raj Lakhani
- Department of ENT, Wexham Park Hospital, Slough, SL2 4HL, UK.
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19
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Campbell RG. Sphenopalatine artery pseudoaneurysm after endoscopic sinus surgery: a case report and literature review. EAR, NOSE & THROAT JOURNAL 2012; 91:E4-11. [PMID: 22359145 DOI: 10.1177/014556131209100215] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Previously reported cases of iatrogenic sphenopalatine artery (SPA) pseudoaneurysm have occurred only after trans-sphenoidal surgery for pituitary tumors or maxillofacial surgery. In this article, the author presents what to the best of her knowledge is the first reported case of an SPA pseudoaneurysm that developed following endoscopic sinus surgery (ESS). The patient was a 76-year-old woman with myelodysplastic syndrome who presented with a 6-month history of unilateral sinus symptoms. She underwent septoplasty and unilateral ESS, which included frontal recess clearance and sphenoidotomy. However, during surgery, severe generalized bleeding was encountered. The bleeding was arrested only after anterior and posterior nasal packing. After two attempts to remove the packing failed, angiography was obtained. It revealed an SPA pseudoaneurysm, which was immediately and successfully embolized. SPA pseudoaneurysm is a rare but significant complication of ESS, and it should be considered in patients with posterior epistaxis after ESS or prolonged posterior nasal packing. The pathogenesis may include intraoperative trauma, infection, pressure necrosis from packing, or a combination of these factors. Optimal management includes either ligation or embolization, depending on anatomic, patient, staff, and resource factors. The author reviews the pertinent anatomy and the pathophysiology, diagnosis, management, and prevention of this rare complication.
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Affiliation(s)
- Raewyn G Campbell
- Department of Ear, Nose and Throat Surgery, The Alfred Hospital, Melbourne, Australia.
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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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Eladl HM, Khafagy YW, Abu-Samra M. Endoscopic cauterization of the sphenopalatine artery in pediatric intractable posterior epistaxis. Int J Pediatr Otorhinolaryngol 2011; 75:1545-8. [PMID: 21955526 DOI: 10.1016/j.ijporl.2011.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Revised: 09/03/2011] [Accepted: 09/04/2011] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the rule of endoscopic sphenopalatine artery cauterization in posterior intractable epistaxis in pediatric age group as regard technical difficulty, efficacy, and safety in children. STUDY DESIGN Retrospective study. PATIENTS AND METHODS From March 2008 to February 2011, 7 children (4 male, 3 female) with idiopathic intractable posterior epistaxis, patients' age ranged from 8 to 14 years (10.7 average). All patients underwent preoperative laboratory investigations to exclude bleeding or coagulation disorders and CT paranasal sinus. All patients underwent endoscopic sphenopalatine artery cauterization (7 procedures for 7 patients, 5 were in the right side and 2 were in the left side). RESULTS postoperative evaluation showed no recurrence for epistaxis during the post operative follow up period. Also, no complications were found. The average follow up period was 17.8 months. CONCLUSIONS Endoscopic cauterization of sphenopalatine artery in pediatric age group was effective and safe technique providing that the surgeon has a good experience regarding pediatric endoscopic sinonasal anatomy. Minimal endoscopic technique in this age group is important to avoid unnecessary operative and postoperative complications. Avoid excessive cauterization to lateral nasal wall in this technique is crucial to avoid unexpected nerve injury or tissue necrosis.
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22
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Shires CB, Boughter JD, Sebelik ME. Sphenopalatine artery ligation: a cadaver anatomic study. Otolaryngol Head Neck Surg 2011; 145:494-7. [PMID: 21562311 DOI: 10.1177/0194599811405593] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To clarify endoscopic anatomy of the sphenopalatine artery (SPA) in relation to intranasal endoscopic landmarks using a human cadaver model and to simplify the surgical approach to SPA ligation. STUDY DESIGN Prospective anatomic study from November to December 2009. SETTING University of Tennessee Health Science Center Gross Anatomy Lab. SUBJECTS Fifty human cadaveric sagittally sectioned heads. METHODS The cadaveric nasal cavities were examined using a 0° endoscope, and the SPA and foramen were identified. The number of nasal cavities in which a transnasal approach successfully revealed the SPA foramen was compared with those that required maxillary antrostomy. The distance from the posterior edge of the maxillary natural ostium to the anterior edge of the SPA foramen was measured. RESULTS Successful ligation of the SPA via a lateral nasal wall incision was achieved in 45 of 50 specimens (90%). The mean distance from the posterior edge of the maxillary natural ostium to the anterior edge of the SPA foramen was 23.79 mm (95% confidence interval, 22.03-25.55). CONCLUSION The method of performing SPA ligation via lateral nasal wall incision alone was successful in 90% of human cadaveric heads. Maxillary antrostomy revealed the SPA in the remainder. No specimen required uncinectomy. The mean distance from the maxillary natural ostium to SPA foramen was more than 2 cm. The routine use of maxillary antrostomy and uncinectomy is not needed to locate the SPA in most nasal cavities and moreover produces unnecessary mucosal trauma in the often medically fragile or coagulopathic patient.
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Affiliation(s)
- Courtney B Shires
- Department of Otolaryngology, University of Tennessee Health Science Center, Memphis, TN, USA
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Agreda B, Urpegui Á, Alfonso JI, Valles H. Ligation of the Sphenopalatine Artery in Posterior Epistaxis. Retrospective Study of 50 Patients. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2011. [DOI: 10.1016/j.otoeng.2010.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Weber RK. Nasal packing and stenting. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2011; 8:Doc02. [PMID: 22073095 PMCID: PMC3199821 DOI: 10.3205/cto000054] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Nasal packs are indispensable in ENT practice. This study reviews current indications, effectiveness and risks of nasal packs and stents. In endoscopic surgery, nasal packs should always have smooth surfaces to minimize mucosal damage, improve wound healing and increase patient comfort. Functional endoscopic endonasal sinus surgery allows the use of modern nasal packs, since pressure is no longer required. So called hemostatic/resorbable materials are a first step in this direction. However, they may lead to adhesions and foreign body reactions in mucosal membranes. Simple occlusion is an effective method for creating a moist milieu for improved wound healing and avoiding dryness. Stenting of the frontal sinus is recommended if surgery fails to produce a wide, physiologically shaped drainage path that is sufficiently covered by intact tissue.
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Affiliation(s)
- Rainer K Weber
- Sektion Nasennebenhöhlen- und Schädelbasischirurgie, Traumatologie, HNO-Klinik, Städtisches Klinikum Karlsruhe, Germany
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Agreda B, Urpegui A, Ignacio Alfonso J, Valles H. [Ligation of the sphenopalatine artery in posterior epistaxis. Retrospective study of 50 patients]. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2011; 62:194-8. [PMID: 21277555 DOI: 10.1016/j.otorri.2010.11.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2010] [Revised: 11/03/2010] [Accepted: 11/05/2010] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the efficacy of endoscopic ligation of the sphenopalatine artery in the treatment of severe posterior epistaxis. METHODS We have carried out a retrospective study on 50 patients hospitalised with posterior recurrent epistaxis, in whom posterior nasal packing was not effective. All of them underwent surgical treatment, with endoscopic ligation of the sphenopalatine artery to control the epistaxis. RESULTS Only seven patients had a new epistaxis after surgery. One of them is being studied for some kind of coagulopathy, another patient was controlled by ligation of the anterior ethmoidal artery and it was necessary to ligate the contralateral sphenopalatine artery in a third patient. The other four patients were controlled with posterior nasal packing and discharged two days after surgery, without any complications. CONCLUSIONS We believe that endoscopic ligation of the sphenopalatine artery is a safe technique, with fewer complications than other methods such as posterior packing or embolisation.
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Affiliation(s)
- Beatriz Agreda
- Servicio de Otorrinolaringología, Hospital Clínico Universitario Lozano Blesa, Zaragoza.
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26
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Timperley D, Sacks R, Parkinson RJ, Harvey RJ. Perioperative and intraoperative maneuvers to optimize surgical outcomes in skull base surgery. Otolaryngol Clin North Am 2010; 43:699-730. [PMID: 20599078 DOI: 10.1016/j.otc.2010.04.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
There are many approaches to obtaining a workable endoscopic surgical field in sinus surgery. With extended sinus and transdural endoscopic surgery, a more rigid approach must be taken. There are 3 main factors that invariably lead to poor surgical outcomes in endoscopic sinus and skull base surgery: bleeding, inadequate access, and unidentified anatomic anomalies. Bleeding is arguably the most common reason for incomplete resection. An understanding of microvascular and macrovascular bleeding allows a more structured approach to improve the surgical field in extended endoscopic surgery. The endoscopic surgeon should always be comfortable in performing the same procedure as an open operation. However, converting or abandoning an endoscopic procedure should rarely occur because much of this decision making should take place preoperatively. Along with poor hemostasis, inadequate access is an important cause of poor outcome. Evaluation of the anatomy involved by pathology but also the anatomy that must be removed to allow adequate exposure is important. This article reviews the current techniques used to ensure optimal surgical conditions and outcomes.
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Affiliation(s)
- Daniel Timperley
- Rhinology and Skull Base, Department of Otolaryngology/Skull Base Surgery, St Vincent's Hospital, 354 Victoria Street, Sydney, NSW 2010, Australia
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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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Lee JT, Keschner DB, Kennedy DW. Endoscopic resection of juvenile nasopharyngeal angiofibroma. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/j.otot.2010.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Welch KC, Stankiewicz JA. A contemporary review of endoscopic sinus surgery: Techniques, tools, and outcomes. Laryngoscope 2009; 119:2258-68. [DOI: 10.1002/lary.20618] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Cassano M, Longo M, Fiocca-Matthews E, Del Giudice AM. Endoscopic intraoperative control of epistaxis in nasal surgery. Auris Nasus Larynx 2009; 37:178-84. [PMID: 19713060 DOI: 10.1016/j.anl.2009.06.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2009] [Revised: 05/19/2009] [Accepted: 06/03/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Epistaxis represents a dangerous post-operative complication of nasal surgery. The advances of endoscopic procedures have also brought along the possibility of a surgical solution of nasal bleeding. These procedures include endoscopic cautery of the bleeding points, and more difficult techniques of endoscopic ligation of the sphenopalatine artery or the anterior ethmoidal artery. These surgical methods permit avoiding nasal packing, a very annoying procedure for the patient. This study aims to evaluate the advantages of this approach at the end of a nasal surgery to prevent routine nasal packing. METHOD 133 subjects were operated on by the same surgeon in the Otorhinolaringology Department of University of Foggia (Italy) from March 2006 to March 2007. 17 (12.8%) patients were submitted to septoplasty, 42 (31.5%) to turbinoplasty (in 22 accompanied by septoplasty) and 74 (55.6%) to endoscopic sinus surgery (ESS) for nasal polyposis or nasal tumors. RESULTS Only 16 cases (12%) underwent nasal packing, while in the remaining 117 (88%) endoscopic control of bleeding permitted avoiding packing. In 53 (39.8%) patients only an endoscopic cauterization of bleeding points was performed; in 29 (21.8%) cases a sphenopalatine artery ligation was necessary. Only 2 subjects (1.5%) underwent anterior ethmoidal artery ligation. In the remaining 34 (25.5%) patients no procedure was necessary, due to the apparently scarce bleeding in the endoscopic vision at the end of surgery. In this group of non-packed patients, only 8 (6.8%) needed a post-operative tamponade while in the group of packed patients, 2 (12.5%) cases had a re-bleeding and a revisional surgery was necessary. CONCLUSION Intra-operative precautional packing is therefore not justified during nasal surgery because of the small percentage of post-operative epistaxis. Intra-operative control of bleeding allowed nasal packing to be avoided in a large percentage of cases.
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Affiliation(s)
- Michele Cassano
- Department of Otorhinolaryngology, University of Foggia, Viale Pinto, Foggia, Italy.
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Seno S, Arikata M, Sakurai H, Owaki S, Fukui J, Suzuki M, Shimizu T. Endoscopic ligation of the sphenopalatine artery and the maxillary artery for the treatment of intractable posterior epistaxis. Am J Rhinol Allergy 2009; 23:197-9. [PMID: 19401049 DOI: 10.2500/ajra.2009.23.3294] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Intractable posterior epistaxis sometimes requires intensive treatment, such as surgery or embolization. Maxillary artery ligation has been widely used for the treatment of intractable posterior epistaxis. It is highly effective, but significant complications may occur, including an oroantral fistula and damage to the infraorbital nerve. Embolization is less invasive and can be performed in poor surgical candidates. However, it has more serious complications, such as facial nerve paralysis and hemiplegia. This investigation evaluates the effectiveness and complications of endoscopic ligation of the sphenopalatine or maxillary artery for the treatment of intractable posterior epistaxis. METHODS Between April 2003 and March 2007, 46 patients were hospitalized for the treatment of severe posterior epistaxis in our University Hospital. Thirty patients were successfully treated by anterior and/or posterior nasal packing, and five patients were treated by electrocoagulation. Endoscopic ligation was performed under general anesthesia in 11 patients (6 men and 5 women; age range, 50-80 years). RESULTS Eight patients underwent endoscopic ligation of the sphenopalatine artery, and three patients underwent endoscopic ligation of the maxillary artery through the middle meatus and posterior antral wall opening. There were no complications, and the patients' postoperative courses were uneventful. Recurrent epistaxis occurred in one patient on oral anticoagulants 15 months after ligation of the sphenopalatine artery, and it was successfully treated by anterior nasal packing. CONCLUSION Endoscopic ligation of the sphenopalatine or maxillary artery is safer than arterial embolization and is less invasive than transantral ligation of the maxillary artery. This technique appears to be a simple and highly effective surgical treatment for patients with intractable posterior epistaxis.
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Affiliation(s)
- Satoshi Seno
- Department of Otorhinolaryngology, Shiga University of Medical Science, Otsu, Shiga, Japan.
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Surgical anatomy of the sphenopalatine foramen and its arterial content. Surg Radiol Anat 2008; 30:583-7. [DOI: 10.1007/s00276-008-0390-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2008] [Accepted: 07/07/2008] [Indexed: 10/21/2022]
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Non-sphenopalatine dominant arterial supply of the nasal cavity: an unusual anatomical variation. The Journal of Laryngology & Otology 2008; 123:689-91. [PMID: 18577275 DOI: 10.1017/s0022215108003058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE We present a rare and clinically relevant anomaly of the sphenopalatine artery in relation to its blood supply of the nasal mucosa, with implications for the management of epistaxis. METHOD Case report and review of the world literature, using Medline through Pub Med (1950-2005), EMBASE (1980-2005) and Ovid (1958-2005), searching for papers using a combination of terms including 'spheno-palatine artery', 'anterior ethmoidal artery' and 'epistaxis'. RESULTS In the presented case of refractory epistaxis, endoscopic and subsequent endovascular management failed to identify a significant supply from the sphenopalatine arteries bilaterally. The main supply was found to be from the anterior ethmoidal arteries. CONCLUSION After a detailed search, the authors failed to locate any similar case in the English literature.
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Abstract
OBJECTIVE To describe the anatomy of the sphenopalatine foramen (SPF) region and possible anatomical variations. STUDY DESIGN Prospective study accomplished from September, 2006, to January, 2007. METHODS The sphenopalatine foramen (SPF) of 61 cadavers were carefully dissected. Presence of the ethmoidal crest, location of sphenopalatine and accessory foramens, and the number of arterial branches emerging through foramens were observed. Data were analyzed in relation to gender, racial group, and symmetry of the cadaver. Prediction of the presence of accessory foramen was evaluated. RESULTS Mixed race cadavers prevailed in 122 nasal fossae dissected (75% males). Ethmoidal crest was present in 100% of the cadavers, being anterior to the SPF in 98.4% of the cases. The most frequent SPF location was the transition of the middle and superior meatus (86.9%). Mean distance from the SPF and accessory foramen to anterior nasal spine was 6.6 cm and 6.7 cm, respectively. Accessory foramen was present in 9.83% of the cases. A single arterial stem emerged through the SPF in 67.2% of the cases, and 100% through accessory foramens. The prevalence analyses showed no differences that were statistically significant (P > 0.05) between gender and racial group. The symmetry analyses showed a strong conformity (P < 0.01) between nasal fossae in relation to the SPF location. There was no statistically significant conformity between nasal fossae and accessory foramen (P = 0.53). None of the variables of interest presents any statistically significant (P > 0.05) association with the presence of the accessory foramen. CONCLUSIONS There are anatomical variations in the lateral nose wall that should be considered for successful endoscopic surgical treatment of severe epistaxis.
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