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Anatomy of the Nose and Paranasal Sinuses
Published in R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne, Scott-Brown's Essential Otorhinolaryngology, 2022
Dustin M. Dalgorf, Richard J. Harvey
The sphenopalatine artery is the major contributing artery (Figure 25.3). It enters through the sphenopalatine foramen inferior to the middle turbinate horizontal attachment. The crista ethmoidalis is a small crest of palatine bone located anterior to sphenopalatine foramen serving as a consistent surgical landmark.
Data and Picture Interpretation Stations Cases 1–42
Published in Joseph Manjaly, Peter Kullar, Alison Carter, Richard Fox, ENT OSCEs: A Guide to Passing the DO-HNS and MRCS (ENT) OSCE, 2019
Joseph Manjaly, Peter Kullar, Alison Carter, Richard Fox
Describe three key steps in managing this patient. Control bleeding using first aid, nasal cautery and nasal packingIntravenous access for intravenous fluid therapy and bloods, including FBCSurgical intervention for recalcitrant bleeding, e.g. sphenopalatine artery ligation
Epistaxis
Published in S. Musheer Hussain, Paul White, Kim W Ah-See, Patrick Spielmann, Mary-Louise Montague, ENT Head & Neck Emergencies, 2018
The nose has an excellent blood supply from both the internal and external carotid arteries, which anastomose extensively within the lateral wall of the nose and septum. The external carotid artery supplies the nose via the facial and maxillary branches. The maxillary artery supply is via the sphenopalatine and greater palatine branches and the facial artery supply is mainly via the superior labial artery. The sphenopalatine artery is the most important blood supply to the nose and it enters the nose via the sphenopalatine foramen before dividing into the posterior septal artery, which runs medially across the face of the sphenoid to the posterior septum and subsequently Little’s area, and the posterior lateral division, which supplies the inferior and middle turbinate. The internal carotid artery contributes the anterior and posterior ethmoid arteries via the ophthalmic artery, and supplies the superior part of the nasal septum and lateral wall.
Underwater posterior nasal neurectomy compared to resection of peripheral branches of posterior nerve in severe allergic rhinitis
Published in Acta Oto-Laryngologica, 2021
Seiichiro Makihara, Mitsuhiro Okano, Syotaro Miyamoto, Kensuke Uraguchi, Munechika Tsumura, Shin Kariya, Mizuo Ando
Posterior nasal nerves arise from the vidian nerve and include parasympathetic nerve fibers and trigeminal nerve fibers [1]. Kikawada found endoscopic posterior nasal neurectomy as an alternative to vidian neurectomy, which is occasionally accompanied by irreversible complications such as decreased lacrimation and numbness of the upper lip, in 1998 [2,3]. This surgical treatment is an effective method to transect the neural networks surrounding the inferior turbinate that cause unregulated nasal hypersensitivity with excess secretion and to overcome the complications of vidian neurectomy. Several surgical procedures for endoscopic posterior nasal neurectomy have been reported [1,2,4,5]. The original procedure is resection of the posterior nasal nerve trunk at the sphenopalatine foramen via the middle nasal meatus without resecting the sphenopalatine artery (SPA) [2]. With this technique, it is very difficult to keep a clear surgical field, and that is why resection of peripheral branches of the posterior nasal nerve in the inferior turbinate has become an alternative to the original endoscopic posterior nasal neurectomy in Japan [4]. This alternative approach is useful and effective, but we believe that resection of the posterior nasal nerve at a more central portion would be more optimal if the surgeon could safely resect at the sphenopalatine foramen.
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
All patients underwent operation in the general anesthesia, gauze strips or other packing materials were removed from the nasal cavity and 2% lidocaine cotton sheets containing 0.1% adrenaline were used to shrink the nasal mucosa. Common bleeding sites in the nasal cavity were examined and excluded. Through the middle meatus of the affected side, a curved incision was made in the lateral wall of the nasal cavity 1 cm in front of the posterior end of the middle turbinate. The upper end of the incision started at the horizontal part of the middle turbinate plate, and the lower end did not extend beyond the attachment point of then inferior turbinate. The mucosa was cut through into the bone surface, expose the top of the vertical plate of the palatine bone and the sphenoid palatine notch, or find the ethmoid crest and locate the sphenoid palatine aperture (Figure 1), the ethmoidal ridges were bitten to reveal the sphenopalatine notch, locate the sphenopalatine hole, reveal the sphenopalatine artery. The bipolar electrocoagulation cauterized and disconnected the SPA. The mucosal flap is recovered and the hemostatic gelatin sponge covers the mucosal flap.
Incidental ethmoidal dural arteriovenous fistula coexisting with a pituitary adenoma exacerbating post-transsphenoidal epistaxis
Published in British Journal of Neurosurgery, 2019
Keisuke Yoshida, Raita Fukaya, Masahito Fukuchi, Yoshihiko Hiraga, Shinya Ichimura, Koji Fuji
Emergency angiography showed extravasation from the posterior septal branch of the sphenopalatine artery (SPA) (Figure 2(A,B)). In addition, an incidental anterior cranial fossa DAVF was detected. It was supplied by the ethmoidal branch of the right ophthalmic artery (OphA) aberrantly originating from the middle meningeal artery (MMA). The DAVF then drained into the anterior segment of the superior sagittal sinus through a dilated prefrontal cortical vein. Selective catheterisation of the SPA was achieved with a microcatheter, and endovascular embolisation was performed using Gelfoam® Sterile Sponge pledgets (Pfizer, Inc.; New York, NY, USA). The bleeding from the oral cavity stopped just after embolisation was achieved. Estimated blood loss was more than 4000 mL by the time haemostasis was achieved. Follow-up CT showed high density in the sphenoid sinus that had not been evident on the postoperative CT but did not show any evidence of intracranial haemorrhage.