This study was performed at the Otorhinolaryngology Clinical Division of the Clinical Hospital of the School of Medicine of the University of São Paulo, São Paulo – SP, Brazil.
Article first published online: 2 JAN 2009
Copyright © 2008 The Triological Society
Volume 118, Issue 1, pages 156–161, January 2008
How to Cite
Pádua, F. G. M. and Voegels, R. L. (2008), Severe Posterior Epistaxis–Endoscopic Surgical Anatomy. The Laryngoscope, 118: 156–161. doi: 10.1097/MLG.0b013e31815708d0
Presented at the 6th European Congress of Oto-Rhino-Laryngology, Head and Neck Surgery (EUFOS) Vienna, June 30–July 4, 2007.
No financial support or funding for this work was obtained.
- Issue published online: 2 JAN 2009
- Article first published online: 2 JAN 2009
- Manuscript Accepted: 31 JUL 2007
- sphenopalatine foramen;
- sphenopalatine artery;
- accessory foramen;
- anatomical variations;
- posterior nasal bleeding
Objective: To describe the anatomy of the sphenopalatine foramen (SPF) region and possible anatomical variations.
Study Design: Prospective study accomplished from September, 2006, to January, 2007.
Methods: The sphenopalatine foramen (SPF) of 61 cadavers were carefully dissected. Presence of the ethmoidal crest, location of sphenopalatine and accessory foramens, and the number of arterial branches emerging through foramens were observed. Data were analyzed in relation to gender, racial group, and symmetry of the cadaver. Prediction of the presence of accessory foramen was evaluated.
Results: Mixed race cadavers prevailed in 122 nasal fossae dissected (75% males). Ethmoidal crest was present in 100% of the cadavers, being anterior to the SPF in 98.4% of the cases. The most frequent SPF location was the transition of the middle and superior meatus (86.9%). Mean distance from the SPF and accessory foramen to anterior nasal spine was 6.6 cm and 6.7 cm, respectively. Accessory foramen was present in 9.83% of the cases. A single arterial stem emerged through the SPF in 67.2% of the cases, and 100% through accessory foramens. The prevalence analyses showed no differences that were statistically significant (P > 0.05) between gender and racial group. The symmetry analyses showed a strong conformity (P < 0.01) between nasal fossae in relation to the SPF location. There was no statistically significant conformity between nasal fossae and accessory foramen (P = 0.53). None of the variables of interest presents any statistically significant (P > 0.05) association with the presence of the accessory foramen.
Conclusions: There are anatomical variations in the lateral nose wall that should be considered for successful endoscopic surgical treatment of severe epistaxis.