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Case 3.17
Published in Monica Fawzy, Plastic Surgery Vivas for the FRCS(Plast), 2023
This is from the facial and ophthalmic arteries:The most important source artery is the facial artery – with its superior labial artery, and angular artery branches.The superior labial artery gives off a columellar branch in 2/3 of people, which is sacrificed in an open tip rhinoplasty, leaving the lateral nasal artery, which is a branch of the angular artery to supply the tip. This may be unilateral or bilateral, and lies 2 mm above the alar groove, so injury from an alar base resection during a concomitant open rhinoplasty may lead to tip necrosis.The ophthalmic artery supplies the upper third – with branches such as the anterior ethmoidal artery, dorsal nasal artery, and external nasal artery.
Iatrogenic CSF rhinorrhea
Published in Jyotirmay S. Hegde, Hemanth Vamanshankar, CSF Rhinorrhea, 2020
Hemanth Vamanshankar, Jyotirmay S Hegde
The most common sites of CSF leak following endoscopic sinus surgery are: cribriform plate and ethmoid (80%), frontal sinus (8%), and sphenoid sinus (4%).27 In the cribriform region, iatrogenic leaks are most common in the lateral wall of the olfactory fossa and fovea ethmoidalis, which is also the medial limit of the frontal recess region. The bone at this region is very thin, ranging from 0.1–1 mm, and is usually damaged if surgical instruments are turned medially during surgery in this region. Also present in this region is the anterior ethmoidal artery. An attempt to use diathermy (especially unipolar) here in order to obtain hemostasis may burn through the bone and dura, thus causing a CSF fistula.28 Attempts to remove cells present on the skull base near the fovea ethmoidalis could be a cause of the leak.29
Periorbital Region and Tear Trough
Published in Ali Pirayesh, Dario Bertossi, Izolda Heydenrych, Aesthetic Facial Anatomy Essentials for Injections, 2020
Colin M. Morrison, Ruth Tevlin, Steven Liew, Vitaly Zholtikov, Haideh Hirmand, Steven Fagien
The ophthalmic artery (OA) is the artery of the orbit originating from the internal carotid artery within the middle cranial fossa. After traveling through the optic foramen, it divides into multiple arterial branches within the orbital cavity [34]. The OA is considered a major arterial shunt between the internal and external carotid arteries.The OA provides anterior and posterior ethmoidal arteries that course through the anterior and posterior ethmoidal foramina, respectively.The anterior ethmoidal artery terminates as the external nasal artery which supplies the lateral nose.
Endoscopic sphenopalatine artery electrocoagulation for refractory epistaxis: a clinical study
Published in Acta Oto-Laryngologica, 2020
Liang Yu, Xiaofei Li, Shujuan Sun, Li Shi, Yuzhu Wan
In this case, endoscopic examination of the nasal cavity under local anesthesia was performed after rebleeding, and pulsatile arterial bleeding was found in the nasal septum in the olfactory fissure area. Bipolar electrocoagulation was performed to stop the blood, and no rebleeding was observed during follow-up. Considering the branch of the septal surface of the anterior ethmoid artery may cause bleeding, therefore, it is necessary to eliminate the common position at the posterior end of the nasal cavity before the SPA electrocoagulation. The SPA electrocoagulation should be regarded as the ultimate treatment method for refractory epistaxis. SPA electrocoagulation has little effect on epistaxis caused by systemic diseases and is not suitable for localized bleeding points. The former is conducive to the treatment of primary diseases such as hematological diseases and liver diseases, while the latter can be treated with nasal packing or coagulation of bleeding points.
Navigation-Assisted Isolated Medial Orbital Wall Fracture Reconstruction Using an U-HA/PLLA Sheet via a Transcaruncular Approach
Published in Journal of Investigative Surgery, 2020
Quang Ngoc Dong, Masaaki Karino, Takashi Koike, Taichi Ide, Satoe Okuma, Ichiro Kaneko, Rie Osako, Takahiro Kanno
Considering the pros and cons of these conventional approaches, the transcaruncular approach used in this study is feasible and simple and leaves a non-visible scar, while the medial canthal ligament and the lacrimal drainage system are well protected and do not appear in the surgical field. The medial rectus muscle is kept intact. The anterior ethmoidal artery does not need to be ligated, and the risk for optic nerve injury is minimized by stopping the dissection when the posterior ethmoidal artery is visible. The limited view is a drawback of this technique. However, using the navigation device, the posterior edge of the fracture defect and also the position of the implant can be easily confirmed. Surgery in the present study took less than 60 min in all cases, and postoperative CT revealed the excellent position of the orbital sheet.
Revision eDCR using a superior pedicled mucosal flap
Published in Orbit, 2019
Sarina K. Mueller, Suzanne K. Freitag, Daniel R. Lefebvre, Nahyoung G. Lee, Benjamin S. Bleier
One of the principal challenges in revision eDCR is the need to surgically identify the correct osteotomy site and maintain long-term patency in the setting of previously instrumented and potentially scarred tissue. As in primary eDCR, the elevation, preservation, and replacement of vascularized mucosal flaps significantly facilitate both surgical exposure and the long-term success of the procedure. However, in the revision patient, the surgeon must assume that the blood supply to the commonly described anterior and posteriorly pedicled flaps26,27 has been compromised. In contrast, both open and eDCR approaches tend to avoid the mucosa of the superior nasal vault which transmits branches of the anterior ethmoid artery.28 This suggests that the blood supply of these superiorly based branches will tend to be intact, even in the setting of a revision procedure. Despite the multiple flap configurations that have been described in literature, none of those techniques describes an endoscopic mucosal sparing technique that uses a superior pedicled mucosal flap for revision eDCR and that takes into account the preserved branches of the anterior ethmoid artery. Here, we describe this technique and compare the anatomical patency rate and functional success rate with those depicted in literature.