Osteologic Classification of the Sphenopalatine Foramen

Abstract

Textbook descriptions and illustrations of the opening of the sphenopalatine foramen (SPF) into the nasal cavity place it above and behind the posterior end of the middle turbinate (i.e., within the superior meatus). Although true for some skulls, this is not the situation for the majority and may be of importance, because the major blood supply to the nasal cavity enters via this route. Having studied 238 lateral nasal walls, the authors propose a classification of the osteology of the sphenopalatine foramen. In class I (35%) the opening of the SPF is purely into the superior meatus with a notch or foramen in the middle turbinate/ethmoidal crest of the palatine bone. In class II (56%) the SPF spans the ethmoidal crest (i.e., opens into both the superior and middle meati). In class III (9%) there are two separate openings into the superior and middle meati. These findings may explain the route of the artery to the inferior turbinate and indicate the need for care in dealing with the posterior end of the middle turbinate. They may also suggest a potential site for dealing with "difficult" epistaxis via an intranasal route.

Estudo anatômico do forame esfenopalatino

“…Based on these numbers, recently published papers [10][11][12] have suggested that there may be anatomical variants in the entrance point of the nasal arterial vessels (the branching pattern of the sphenopalatine artery, which in 95% of cases divides close to the sphenopalatine foramen, in the pterygopalatine fossa 10 ); this may depend on the number of foramens, and may be the cause of failure in the treatment of severe epistaxis or failure in arterial ligature. 4,12,13 According to some authors, the sphenopalatine foramen may be found in the superior nasal meatus in the nasal cavity. 6,14 However, if its position on the lateral nasal wall is established by the relation with the ethmoidal crest of the palatine bone, onto which it joins the posterior portion of the middle nasal turbinate, other studies locate it in the middle and/or superior nasal meatuses; 9,13 it is used as an anatomical landmark in endoscopic surgery.…”

“…4,12,13 According to some authors, the sphenopalatine foramen may be found in the superior nasal meatus in the nasal cavity. 6,14 However, if its position on the lateral nasal wall is established by the relation with the ethmoidal crest of the palatine bone, onto which it joins the posterior portion of the middle nasal turbinate, other studies locate it in the middle and/or superior nasal meatuses; 9,13 it is used as an anatomical landmark in endoscopic surgery. 15 It is essential that surgeons possess ample knowledge of the anatomy, physiology, surgical techniques and complications, 16 among other requirements, to undertake arterial ligature and other endoscopic procedures in the nasal cavity and avoid possible failures.…”

The possible relationship between epistaxis and protein Z plasma levels

“…Epistaxis is classified clinically into anterior and posterior, and 90-95% of those are on the anterior region and most of them are on the little region, reveals in Kiesselbach plexus [1,2]. Sphenopalatine artery is responsible for most of the posterior epistaxis [3]. Bleeding caused by local traumas rather than anterior, whereas bleeding caused by systemic diseases usually generate from the posterior [3,4].…”

“…Sphenopalatine artery is responsible for most of the posterior epistaxis [3]. Bleeding caused by local traumas rather than anterior, whereas bleeding caused by systemic diseases usually generate from the posterior [3,4].…”

Estudo da anatomia da região do forame esfenopalatino na parede lateral do nariz através da dissecção endoscópica em cadáveres

“…Quando duas ramificações arteriais estão presentes na cavidade nasal, a artéria nasal posterior lateral está situada mais anterior e inferior no forame (Wareing et al, 1998;Bolger et al, 1999 Figura 33. Parede lateral da cavidade esquerda do nariz.…”