Sphenopalatine Foramen Localization: Radiological and Surgical Morphometric Analysis for Localization of Sphenopalatine Artery

Background Transnasal endoscopic sphenopalatine artery ligation is becoming the procedure of choice for surgical management of intractable posterior epistaxis. Landmarks for localization of the sphenopalatine foramen can assist in rapid surgical exposure of the sphenopalatine artery. Objective This study examined distances from easily identified endoscopic surgical landmarks to the sphenopalatine foramen. Methods By using computed tomography of the sinus to study radiologic anatomy in 50 adults, distances were measured between five simple endoscopic landmarks and the sphenopalatine foramen. The two-tailed t-test was used for statistical analysis. Results Right- and left-sided measurements were similar. The mean (standard deviation [SD]) anteroposterior distances to the sphenopalatine foramen were the following: from the maxillary line (36.7 ± 5.5 mm), anterior head of the middle turbinate (33.8 ± 6.7 mm), basal lamella (11.8 ± 1.9 mm), and choanal arch (–9.2 ± 1.4 mm). The mean (SD) distance in the vertical dimension from the nasal floor was 26.6 ± 2.6 mm. Female patients had statistically shorter distances to the sphenopalatine foramen from the maxillary line, anterior head of the middle turbinate, choanal arch, and nasal floor. Conclusion Reliable endoscopic landmarks exist in relation to consistent anatomic structures and can be used to help quickly estimate the location of the sphenopalatine foramen at the onset of the procedure.

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Endoscopic sphenopalatine foramen cauterization is an effective treatment modification of endoscopic sphenopalatine artery ligation for intractable posterior epistaxis

European Archives of Oto-Rhino-Laryngology ◽

10.1007/s00405-020-06005-8 ◽

2020 ◽

Vol 277 (9) ◽

pp. 2463-2467 ◽

Cited By ~ 1

Author(s):

Wirach Chitsuthipakorn ◽

Kachorn Seresirikachorn ◽

Dichapong Kanjanawasee ◽

Kornkiat Snidvongs

Keyword(s):

Effective Treatment ◽

Artery Ligation ◽

Treatment Modification ◽

Sphenopalatine Artery ◽

Sphenopalatine Foramen

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Surgical field visualization in patients with polyposis rhinosinusitis

Medical Council ◽

10.21518/2079-701x-2021-6-106-112 ◽

2021 ◽

pp. 106-112

Author(s):

H. B. Bebchuk ◽

N. A. Daikhes ◽

V. M. Averbukh ◽

M. Z. Dzhafarova ◽

T. I. Garashchenko ◽

...

Keyword(s):

Nasal Polyposis ◽

Endoscopic Examination ◽

Surgical Anatomy ◽

Saline Irrigation ◽

Sphenopalatine Artery ◽

Sphenopalatine Foramen ◽

Grade 5 ◽

Before And After ◽

Surgical Field ◽

Grade 8

Introduction. Patients with nasal polyposis are predisposed to diffuse intraoperative bleeding, that could highly impair surgical field visualization. The absence of a universal technique of improving surgical field visualization became a reason for searching the specific hemostatic methods.Objective: to evaluate the efficiency of sphenopalatine artery and/or its branches coagulation as a method of hemostasis in endoscopic surgery for nasal polyposis and to describe the surgical anatomy of sphenopalatine artery.Materials and methods. Endoscopic coagulation of sphenopalatine artery and/or its branches was performed among 30 patients with nasal polyposis. Surgical field visualization was graded by Boezaart and Wormald scales before and after coagulation.Results and discussion. Intraoperative attempts to achieve the hemostasis using warm (490С) saline irrigation and then application of xylometazoline (0.1%-10ml) and lidocaine (10%-4ml) were ineffective among 28 patients with initial grade 8 and among 2 patients with grade 9 according to Wormald scale. Sphenopalatine artery and/or its branches coagulation was effectively performed in these patients, obtaining the hemostasis in 100% of cases (р < 0,001). The initial surgical field grade improved to grade 5 by Wormald scale in 9 patients (30%), to grade 6 in 17 patients (56,7%) and to grade 7 in 4 patients (13,3%). Only one artery (trunk of sphenopalatine artery) was observed in 18 patients (60%), crossing the sphenopalatine foramen, and 2 arteries (posterior septal artery and posterior lateral nasal artery) – in 12 patients (40%). Endoscopic examination revealed no signs of mucosal atrophy in postoperative period.Conclusion: The appropriate choice of hemostatic technique depends on grades of surgical field visualization. If there is a grade 8–9 by Wormald scale, endoscopic coagulation of sphenopalatine artery and/or its branches is an effective and safe method to improve surgical field visualization.

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Endoscopic Anatomy of the Sphenopalatine and Posterior Nasal Arteries: Implications for the Endoscopic Management of Epistaxis

American Journal of Rhinology ◽

10.1177/194589240301700111 ◽

2003 ◽

Vol 17 (1) ◽

pp. 63-66 ◽

Cited By ~ 43

Author(s):

Heather R. Schwartzbauer ◽

Mona Shete ◽

Thomas A. Tami

Keyword(s):

Nasal Cavity ◽

Blood Supply ◽

Endoscopic Management ◽

Arterial Ligation ◽

Sphenopalatine Artery ◽

Sphenopalatine Foramen ◽

Arterial Blood ◽

Relationship Of ◽

Anatomic Region ◽

Anatomic Relationship

Background Refractory posterior epistaxis is a challenge for otolaryngologists. Most algorithms for managing this condition ultimately call for interrupting the arterial blood supply to the nasal mucosa. Traditionally, this was accomplished either by transantral arterial ligation or by arteriographic-guided embolization. More recently, the endonasal endoscopic approach has also been described. Because the primary blood supply to the posterior nasal cavity is derived from the terminal branches of the sphenopalatine and the posterior nasal arteries, we conducted this anatomic study to examine and describe the anatomic relationship of these two arteries as they exit the pterygopalatine fossa and enter the nasal cavity. Methods We performed endoscopic dissections of this anatomic region in nine fresh and one formalin-preserved cadaver specimens. A total of 19 sides were examined. Results In 3 of 19 specimens (16%), the sphenopalatine artery branched from the sphenopalatine artery within the sphenopalatine canal, allowing the two arteries to exit together. In 8 of the 19 specimens (42%), the sphenopalatine artery exited much more posteriorly, yet from within a shared posteriorly elongated sphenopalatine foramen. In the remaining eight specimens (42%), the sphenopalatine artery exited through a distinct foramen directly posterior to the larger sphenopalatine foramen. Conclusion Understanding this anatomic relationship is important in performing endoscopic arterial ligation. If the sphenopalatine artery is not specifically identified and ligated, an important component of the posterior nasal circulation will not be addressed adequately by this surgical approach.

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Morphometric evaluation of the sphenopalatine foramen for endonasal surgery

Rhinology Journal ◽

10.4193/rhino09.151 ◽

2010 ◽

Vol 48 (4) ◽

pp. 441-445

Author(s):

A.B. Antunes Scanavini ◽

J.A.C. Navarro ◽

S.R.M.C. Megale ◽

R.S. Lima ◽

W.T. Anselmo-Lima

Keyword(s):

Anatomical Study ◽

Lateral Nasal Wall ◽

Mean Values ◽

Sphenopalatine Artery ◽

Sphenopalatine Foramen ◽

Anterior Nasal Spine ◽

Nasal Floor ◽

The Mean ◽

Numerical Variation ◽

Study Setting

OBJECTIVE: Ligation of the sphenopalatine artery is used to treat severe nasal haemorrhage. Despite the high rates of success reported, errors and complications may occur in locating the sphenopalatine foramen (SPF) through which the vasculonervous structures penetrate the nasal cavity. Thus, the objective of this study was to investigate the numerical variation of the SPF, its relation to the ethmoid bone crista of the palatine bone in the lateral nasal wall, its distance from the anterior nasal spine and the angle between this distance and the anterior nasal floor. DESIGN: Anatomical study. SETTING: Regional tertiary reference center. MATERIAL AND INTERVENTIONS: Fifty-four hemiskulls were submitted to anatomical study and measurements were made on more than 12 dissected hemiskulls using the Image Tool 3.0 software. RESULTS: The SPF was single in 87% of the specimens, and more than one orifice was present in 13%. In most specimens it was possible to establish a relation with the ethmoid crista, which is a surgical reference for the SPF location. The mean values of the measurements were significantly higher in the hemifaces than in the hemiskulls, ranging from 54 to 63 mm, and angulation ranged from 20 to 32 degrees. CONCLUSIONS: The study demonstrated that in most specimens studied the SPF was single and located in the superior nasal meatus. The distances measured suggest that these values can be used as distance references for the use of the endoscope for ligation or endonasal cauterization of the branches of the sphenopalatine artery, preventing possible errors and complications.

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Sphenopalatine artery ligation: technical note

The Journal of Laryngology & Otology ◽

10.1258/002221505774481354 ◽

2005 ◽

Vol 119 (10) ◽

pp. 810-812 ◽

Cited By ~ 17

Author(s):

David D Pothier ◽

Samuel MacKeith ◽

Robin Youngs

Keyword(s):

Surgical Technique ◽

Surgical Management ◽

Nasal Mucosa ◽

Lateral Wall ◽

First Aid ◽

Technical Note ◽

Review Of The Literature ◽

Artery Ligation ◽

Sphenopalatine Artery ◽

Sphenopalatine Foramen

Epistaxis is a common problem. Most patients presenting to hospital will stop bleeding with simple first-aid measures or with nasal packing. Those who do not stop will usually require surgical management. For persistent posterior epistaxis, the sphenopalatine artery may be ligated as the artery leaves the sphenopalatine foramen to enter the nasal mucosa of the lateral wall of the nose. This may be performed endoscopically. We describe the anatomy of the area and the surgical technique. We also present a brief review of the literature on this technique.

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Morphometric Analysis of the Hepatocytes from Fish Exposed to Arsenic

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100091391 ◽

1976 ◽

Vol 34 ◽

pp. 282-283

Author(s):

Elsie M. B. Sorensen

Keyword(s):

Morphometric Analysis ◽

Arsenic Concentration ◽

Ultrastructural Changes ◽

Sodium Arsenate ◽

Lepomis Cyanellus ◽

Mammalian Counterpart ◽

Intracellular Changes ◽

Green Sunfish ◽

Organic Pesticides

The detoxification capacity of the liver is well documented for a variety of substances including ethanol, organic pesticides, drugs, and metals. The piscean liver, although less enzymatically active than the mammalian counterpart (1), contains endoplasmic reticulum with an impressive repertoire of oxidizing, reducing, and conjugating abilities (2). Histopathologic changes are kncwn to occur in fish hepatocytes following in vivo exposure to arsenic (3); however, ultrastructural changes have not been reported. This study involved the morphometric analysis of intracellular changes in fish parynchymal hepatocytes and correlation with arsenic concentration in the liver.Green sunfish (Lepomis cyanellus, R.) were exposed to 0, 30, or 60 ppm arsenic (as sodium arsenate) at 20°C for 1, 2, or 3 week intervals before removal of livers for quantification of the arsenic burden (using neutron activation analysis) and morphometric analysis of ultrastructural alterations. Livers were cut into 1 mm cubes for fixation, dehydration, and embedding.

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