Artéria esfenopalatina: desafio cirúrgico na epistaxe

Abstract

Knowl edge on the anatomy of the sphenopalatine artery (SPA) and its branches is fundamental for the success of the endoscopic treatment of posterior epistaxis. However, the complex anatomical variations seen in the irrigation of the nasal cavity poses a significant surgical challenge.Objective: This paper aims to describe the endoscopic anatomy of the SPA in human cadavers. Materials and Methods:This is a contemporary cross-sectional cohort study carried out between April 2010 and August 2011. The presence of the ethmoidal crest on the lamina perpendicular to the palatine bone and the location of the principal sphenopalatine foramen (PSF) and the accessory sphenopalatine foramen (ASF) were analyzed in 28 cadavers, and the branches emerging from the foramens were counted.Results: Fifty-six nasal fossae were analyzed. The ethmoidal crest was present in 96% of the cases and was located anteriorly to the PSF in most cases. The PSF was located in the transition area between the middle and the superior meatus in all cases. The ASF was seen in 12 cases. Most nasal fossae (n = 12) presented a single bilateral arterial trunk emerging from the PSF. In other cases, three (n = 8) or two (n = 5) arterial trunks emerged bilaterally from the PSF. In most cases, the SPA emerged as a single trunk from the ASP. Conclusions:The anatomy of the SPA is highly variable. The success of the treatment for severe epistaxis relies heavily on adequate knowledge of the possible anatomical variations of the sphenopalatine artery.

Nasosinusal Endoscopic Anatomy and Physiology

“…Located in the nasal cavity's posterior region, this artery is responsible for the most severe episodes of epistaxis. 8 The maxillary artery, a branch of the external carotid artery, originates from the sphenopalatine artery, that passes through the sphenopalatine foramen and provides branches that irrigate the lateral and septal nasal wall mucosa. 5…”

Intraoperative variations of the sphenopalatine artery between epistaxis and non-epistaxis cases: a comparative endoscopic analysis

“…With anatomical variations of the arteries supplying the nasal cavity, particularly the main SPA and its terminal branches [7,8], the likelihood of recurrent epistaxis is ever so often present [5,9,10]. The risk of recurrent epistaxis has been always associated with the preoperative localization of bleeding source, surgeon's experience, intraoperative visualization, and presence of anatomical variations [11]. In surgery, the key for the efficient control of severe epistaxis is the accurate identification of bleeding source that is similarly necessary for selecting the appropriate management procedure [5,6,[12][13][14].…”