Vascular Anatomy of the Inferior Turbinate and Its Clinical Implications

Abstract

Background Published reports on the vascular anatomy of the inferior turbinate (IT) are limited. Historical papers report the IT artery as a tributary off the posterior lateral nasal artery (PLNA), but this has not been our clinical experience. Objective The purpose of this study was to examine the arterial blood supply to and the branching pattern within the IT. We discuss this is the context of IT surgery and relate it to postoperative bleeding complication rates. Methods Endoscopic dissection was performed on 16 cadaver heads (24 sides) to determine the origin of the IT artery. Intraoperative surgical videos were analyzed in 50 patients to uncover the vascular branching pattern within the IT. A retrospective review of bleeding complications in patients undergoing IT reduction surgery was also conducted. Results In 17 of 24 sides (70.8%), the IT artery arose either exclusively (54.2%) or partly (16.6%) off the descending palatine artery (DPA). As a branch off the DPA, the IT artery exited the pterygopalatine fossa through a foramen located 7.7 ± 3.0 mm from posterior edge of the IT, 8.4 ± 3.1 mm above the nasal floor and 1.6 ± 2.1 mm below the insertion of the IT bone onto the lateral nasal wall. The mean number of arteries cascading within the IT was 2.7 ± 0.5. Moreover, 112 patients underwent IT reduction surgery and 2 (1.8%) experienced postoperative epistaxis. Conclusion The IT artery has major contributions from the DPA. Most commonly 3 arteries branch within the IT. Knowledge of this vascular anatomy may minimize bleeding associated with IT reduction surgery.

How I Do It: Inferior Turbinectomy: Modified Techniques for Submucosal Resection

“…A recent anatomical study showed that the primary blood supply of the inferior turbinate is through the descending palatine artery and its branches within the inferior turbinate. 5 These branches were observed in the periosteum when dissecting in the subperiosteal plane. The submucosal tissue underlying the mucosa is carefully resected while observing the contour and movement of the mucosa.…”

The anatomy of the foramina and efferent nerve fibers from the pterygopalatine ganglion in posterolateral nasal wall

“…Care should be taken not to damage the descending palatine and branches from the glossopharyngeal nerve as this may result in palatal paresthesia. During PNN, division of the SPA is also controversial with some surgeons recommending it and others not 20,21 . Failure to divide the SPA may result in the preservation of a significant number of PPG nerve fibers that run with the vasculature.…”

“…During PNN, division of the SPA is also controversial with some surgeons recommending it and others not. 20 , 21 Failure to divide the SPA may result in the preservation of a significant number of PPG nerve fibers that run with the vasculature.…”

Editorial

“…Other exciting and impactful articles are presented in the realm of CRS, including the Roland et al 13 study that seeks to characterize CRS with nasal polyp subtypes based on radiographic imaging and the Schertzer et al 14 study by the same group, which describes the prevalence of comorbid allergic rhinitis and the predictable anatomic location of respiratory epithelial adenomatoid hamartoma (REAH) that is also present in central compartment atopic disease. Cadaveric studies by Li et al 15 and Scott et al 16 elegantly describe the prelacrimal approach to access the antero-lateral triangle of the middle cranial fossa 15 and the blood supply to the inferior turbinate from the descending palatine artery, which may be utilized in the reconstruction of anterior skull base defects. 16 This issue promises to engage the reader in a range of interesting and innovative topics, which has become the hallmark of AJRA.…”

“…Cadaveric studies by Li et al 15 and Scott et al 16 elegantly describe the prelacrimal approach to access the antero-lateral triangle of the middle cranial fossa 15 and the blood supply to the inferior turbinate from the descending palatine artery, which may be utilized in the reconstruction of anterior skull base defects. 16 This issue promises to engage the reader in a range of interesting and innovative topics, which has become the hallmark of AJRA. We trust that you will find it useful in advancing your understanding of the topics that continue to provide challenges in the care of rhinologic disease.…”