Endoscopic Approach to Greater Palatine Artery to Control Recurrent Anterior Epistaxis

Abstract

Objectives: (1) Describe the anatomy of the incisive foramen.(2) Describe the endoscopic approach to the greater palatine artery. (3) Recognize the importance of the greater palatine artery as a cause of recurrent anterior epistaxis.Methods: Cadaveric and radiographic study of the incisive foramen; illustrative case series. Seventy computed tomography (CT) scans were reviewed, and measurements were made of the incisive foramina's distance to the anterior nasal spine and subnasale. An endoscopic approach to the incisive foramen was completed in 20 cadavers, and measurements of the distance from the anterior nasal spine to the incisive foramen were documented. We also present an illustrative case series of patients who underwent endoscopic cautery of the greater palatine artery.Results: Radiographic review of the incisive foramen revealed a mean anterior nasal spine to incisive foramen distance on the right and left of 7.9 and 8.1 mm, respectively. The mean distance from the subnasale to incisive foramen on the right and left were 24.7 and 24.9 mm, respectively. Cadaveric measurements preliminarily correspond to radiographic measurements.Conclusions: Endoscopic cauterization of the greater palatine artery is a safe and effective method to control recurrent anterior epistaxis. The incisive foramen can be predictively found within 1 cm of the anterior nasal spine. Preoperative evaluation of a CT scan can help aid a surgeon in determining the relative contribution of the greater palatine artery to the anterior septal blood supply, and guide surgical approach to control recurrent anterior epistaxis. Our case series corroborates the above. Endoscopic Balloon Dacryocystorhinostomy Kevin E. McLaughlin, MD (presenter)Objectives: (1) Describe new endoscopic balloon technique for dacryocystorhinostomy. (2) Review preliminary outcomes of endoscopic balloon DCR.Methods: This study has 2 parts. The first entails a cadaver study looking at feasibility of applying balloon dilation technology to nasolacrimal duct obstruction. Five cadavers (10 sides) were used to confirm the technique. All 10 nasolacrimal ducts were successfully cannulated and dilated with a 5 × 16 mm balloon via a 70° guide. The second part of the study details our preliminary experience using this technique in patients referred to a tertiary rhinology clinic for nasolacrimal duct obstruction.Results: A total of 5 patients have enrolled in our prospective study. All patients were successfully cannulated. Follow-up ranges from 1 to 6 months. Resolution or decrease of preoperative epiphora has been noted in all 5 patients.Conclusions: Transnasal endoscopic balloon dilation of the nasolacrimal duct system may be a possible therapeutic option for the treatment of nasolacrimal duct obstruction. Furthermore, this may be a particularly attractive option for patients who are not candidates for a general anesthetic or cannot be taken off of anticoagulant medication. Further study is warranted.