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Ligation of the sphenopalatine and posterior nasal arteries is indicated for posterior epistaxis as initial treatment or when conservative measures fail. In some patients, a transnasal approach or its alternative transantral approach are not possible due to tumor filling the nasal corridor, pterygopalatine fossa, or maxillary sinus. Aim of this study was to evaluate feasibility of endoscopically assisted transoral approach for the ligation of the maxillary artery (MA). Six fresh cadaver specimens (12 sides), previously prepared with intravascular injections of colored latex, were dissected. A combined transnasal and transoral approach exposed the MA from the deep belly of the temporalis muscle laterally to its terminal branches medially. Anatomical relationships of the MA with the deep belly of the temporalis muscle and the lower head of the lateral pterygoid muscle, and feasibility of access to the MA via a transoral approach were assessed. In all specimens, the MA was found at the point where horizontal fibers of the lower head of the lateral pterygoid muscle cross the vertical fibers of the deep belly of the temporalis muscle. In 5 specimens, the artery ran anteriorly and laterally to lower head of the lateral pterygoid muscle, and in 1 specimen, it ran posteriorly and medially to this muscle, diving between its fibers. The modified endoscopically assisted transoral approach is feasible to ligate the MA. It can be used for proximal vascular control in cases when transnasal and transantral approaches are not viable.

Background:The rhinoplasty techniques which are described by most authors are applied on leptorrhine-type noses and have some or no success at all in platyrrhine-and mesorrhine-type noses (Mestizo nose) as for the former reduction and removal techniques are used; whereas, in the latter, increase and elevation techniques are used. Objective. To provide an alternate surgical solution which offers proper results in patients with mesorrhine-or platyrrhine-type nose.Materials and methods: Pre-and post-operative photographic records of 200 patients were utilized in this investigation. The same surgical technique was used in all cases, with variations related to the size and severity of the case.Results: In a case in which no cardinal points were set, some loss of the nasal tip and the natural luminous points in it, as well as some upper depression of lateral crura, were noted. In a case in which no anterior elongated trapezoidal graft was placed, there was no adequate definition of the nasal tip in the natural form of its characteristic double fold. Conclusion:Using this technique can help to define, thin, project and turn the nasal tip, give the height as desired, and lift the nasal dorsum when required. This is a highly accessible technique to lift the dorsum through osteo-cartilaginous or cartilaginous grafts with the anterior support (nasal tip) strengthened. This technique also works to increase the strength of tissue by providing an excellent structural support to the axis columella-alar-nose tip, without any elasticity or movement loss since the grafts are sufficiently thin.

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