Anatomy of the Skull Base and Infratemporal Fossa
John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed in Paediatrics, The Ear, Skull Base, 2018
The second part of the maxillary artery gives off five branches to the soft tissues: lateral and medial pterygoid musclestemporalis musclelingual and long buccal nerves. The third part of the artery divides in the pterygopalatine fossa, these five branches accompanying nerves including branches of the pterygopalatine ganglion, supplying the orbit, nose and palate. Of note, the sphenopalatine artery enters the nasal cavity through the sphenopalatine foramen to form the cavity’s principal arterial supply. Endoscopic cautery or ligation of this artery is performed for persistent epistaxis; however, as mentioned previously, it rarely presents as one arterial trunk, as it divides in two or more (up to 10 branches) just after exiting the sphenopalatine foramen.
Anatomy of the Nose and Paranasal Sinuses
John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie in Basic Sciences Endocrine Surgery Rhinology, 2018
Both the internal and external carotid arteries supply the lateral nasal wall. The sphenopalatine artery contributes the majority of the arterial supply to the turbinates and lateral nasal wall (Figure 87.13). It enters through the sphenopalatine foramen which lies just inferior to the horizontal attachment of the middle turbinate. The sphenopalatine foramen is formed by the sphenopalatine notch of the palatine bone in articulation with the sphenoid bone. The crista ethmoidalis is a small crest of the perpendicular plate of the palatine bone located anterior to sphenopalatine foramen and serves as a consistent and reliable landmark to identify this vessel during endoscopic dissection.5 The sphenopalatine artery commonly branches lateral to the crista ethmoidalis with many variations in the branching pattern. In one cadaver study, 97% of specimens had two or more branches of the sphenopalatine artery medial to the crista ethmoidalis.6 It is critical that the surgeon is aware of these variations and controls all branches to ensure successful endoscopic ligation of the sphenopalatine artery for epistaxis. If more proximal vascular control is required, the internal maxillary artery can be ligated in the pterygopalatine or infratemporal fossa by removal of the posterior wall of the maxillary sinus.
Data and Picture Interpretation Stations Cases 1–42
Joseph Manjaly, Peter Kullar, Alison Carter, Richard Fox in ENT OSCEs: A Guide to Passing the DO-HNS and MRCS (ENT) OSCE, 2019
Name the arteries supplying the nasal septum. Blood supply from the internal and external carotid arteriesSphenopalatine artery and greater palatine artery (from the maxillary artery, a branch of the external carotid)Anterior ethmoidal artery (from the ophthalmic artery from the internal carotid)Branches of the facial artery (from the external carotid)
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.
Related Knowledge Centers
- Maxillary Artery
- Sphenopalatine Foramen
- Artery
- Nasal Cavity
- Nasal Septum
- Nosebleed
- Nose
- Nasal Meatus
- Posterior Lateral Nasal Arteries
- Posterior Septal Branches of Sphenopalatine Artery