The sphenopalatine artery, formerly known as the nasopalatine artery, is the terminal branch of the maxillary artery that is the main supply to the nasal cavity. It is colloquially know as the artery of epistaxis given its common involvement in cases of nose bleeds.
Full Answer
What is the function of the sphenopalatine artery?
The sphenopalatine artery (SPA) serves as the major supply to the nasal fossa and enters the nasal cavity through the sphenopalatine foramen. The foramen is located on the posterior aspect of the lateral nasal wall posterior to the middle turbinate. The SPA most commonly splits into a septal and lateral branch just as it passes through the foramen.
Where does the sphenopalatine artery supply the nasal cavity?
The sphenopalatine artery (SPA) serves as the major supply to the nasal fossa and enters the nasal cavity through the sphenopalatine foramen. The foramen is located on the posterior aspect of the lateral nasal wall posterior to the middle turbinate.
What is the sphenopalatine foramen?
Along the posterior, lateral wall of the nasal cavity is the sphenopalatine foramen, a tiny hole through which the sphenopalatine artery enters the nasal cavity. The sphenopalatine artery is the last branch of the maxillary artery, which is a branch of the external carotid artery, a major artery supplying the head and neck.
What is the difference between sphenopalatine and infraorbital arteries?
The sphenopalatine artery terminates in many branches supplying the nasal cavity, septum and conchae. The infraorbital artery exits the infraorbital foramen and divides into the lateral nasal and dorsal nasal arteries which supply the soft tissues of the muzzle.
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What is the SPA?
The SPA divides into the lateral nasal artery and the posterior septal nasal artery, which supply the lateral nasal wall and posterior septum, respectively. The posterior septal nasal branch is often termed the posterior nasal artery and runs across the inferior aspect of the sphenoid rostrum.
What artery is identified with a maxillary antrostomy?
Make a large maxillary antrostomy to identify the sphenopalatine artery and the posterior nasal artery.
What is the Kiesselbach plexus?
The Kiesselbach plexus, also known as the Little area, is a localized region of mucosa of the anteroinferior nasal septum. The plexus is principally supplied by branches and anastomoses of the sphenopalatine, superior labial, and anterior ethmoidal arteries and is the most common site of anterior epistaxis.
How far do the anterior and posterior ethmoidal arteries exit?
The anterior and posterior ethmoidal arteries usually exit the orbit 24 mm and 36 mm posterior to the lacrimal crest, respectively, leaving the optic nerve only 6 mm behind the posterior ethmoidal arteries.
Where is the sphenopalatine foramen located?
The sphenopalatine foramen is located on the lateral nasal wall at the superior aspect of the vertical plate of the palatine bone. It can be found where the inferior portion ...
How many branches does a SPA have?
The SPA most commonly splits into a septal and lateral branch just as it passes through the foramen. Alternatively, the SPA can have three or more branches and may split within the pterygopalatine fossa prior to entering the nasal fossa. These variations are important to consider when attempting surgical ligation.
Which artery divides off the ophthalmic artery?
After the lacrimal artery divides off the ophthalmic artery, it continues along the superior and medial aspect of the orbit. The anterior and posterior ethmoidal arteries split off medially through the orbital wall into the ethmoid sinus, entering the nasal cavity superiorly through the cribriform plate ( Fig. 35-2 ).
What is the artery of epistaxis?
49804. Anatomical terminology. The sphenopalatine artery ( nasopalatine artery) is an artery of the head, commonly known as the artery of epistaxis.
Which artery is responsible for the most severe posterior nosebleeds?
The sphenopalatine artery is the artery responsible for the most serious, posterior nosebleeds (also known as epistaxis). It can be ligated surgically or blocked under image guidance with minimally invasive techniques by interventional radiologist using tiny microparticles to control such nosebleeds.
Where is the sphenopalatine artery?
The sphenopalatine artery is a branch of the maxillary artery which passes through the sphenopalatine foramen into the cavity of the nose, at the back part of the superior meatus. Here it gives off its posterior lateral nasal branches .
How to enter a sphenoid sinus?
A pneumatized sphenoid sinus can be entered by fracturing the vomer or using a chisel or drill. The sphenoidectomy is carried out superiorly to the planum sphenoidale, inferiorly to the floor of the sinus, and laterally just prior to reaching the sphenopalatine foramen. Care is taken to avoid injuring the sphenopalatine artery near the inferolateral border of the sphenoid ostium (at the 7 o’clock position for the right side and the 5 o’clock position for the left side). A fragment of the vomer is preserved to mark the midline. Mucosa within the sphenoid sinus is stripped with a cup forcep to reduce risk of post-operative mucocele. Septae within the sphenoid sinus are removed, after noting their relation to the cavernous carotid canals on pre-operative image. Inspection at this point, prior to entering the sella, should reveal the carotid canals, the planum, the opticocarotid recesses, and the clivus.
What is the nasal cavity phase?
The nasal cavity phase includes the nasal turbinates and nasal septum. The posterior nasal bony septum is commonly resected, carefully sparing the overlying septal mucosa. The bony septum includes the vomer and perpendicular plate of the ethmoid with small components from the palatal bone and sphenoid bone. The vomer and ethmoid contributions articulate with the cartilaginous nasal septum.
What happens if you bleed through a major artery?
Torrential bleeding from a major artery may lead to rapid blood loss and hemodynamic instability and needs immediate control. The sphenopalatine artery, internal carotid artery (ICA), cavernous portion of ICA, and cavernous venous sinus are the structures vulnerable to damage during transsphenoidal approach for pituitary tumors. Bleeding through a major vessel during an endoscopic surgery obscures the vision and is impossible to take control of. The majority of vascular injuries may be avoided if the surgeon adheres to a strict midline course. Important vessels traverse the base of the skull, and any surgery in this area carries significant risk of vessel damage. Intraoperative aneurysm rupture is not an uncommon entity and requires urgent control by means of a clip.
Where are the turbinates located?
There are commonly three turbinates on either side of the nasal septum. The superior and middle turbinates originate from the ethmoid bone, and the inferior turbinate originates from the medial maxillary sinus. The bone within each turbinate is trebeculated and pneumatized. These structures, thought to help create laminar airflow and warm the inspired air, are typically lateralized and compressed to achieve access to the sphenoid sinus. In unusual cases, one or two of the turbinates can be resected to improve lateral access for larger tumors. The blood supply of these turbinates is also shared between the sphenopalatine artery and ethmoidal arteries. In particular, the blood supply of the middle turbinate originates from the base of the sphenopalatine artery, and care must be taken to preserve the main trunk if resecting this turbinate. The middle turbinate mucosa can be used as a pedicled vascular flap as well to reinforce lateral or anterior skull-base defects.
Which artery is the anterior ethmoidal artery?
The posterior ethmoidal artery regularly arises from the proximal portion of the ophthalmic artery and runs between the superior rectus and superior oblique muscle and passes through the posterior ethmoidal foramen located in close proximity to the optic canal ( Caliot, Plessis, Midy, Poirier, & Ha, 1995; Erdogmus & Govsa, 2006 ). The anterior ethmoidal artery is larger in diameter than the posterior ethmoidal artery and variably originates from a distal part of the ophthalmic artery and turns towards the medial wall of the orbit. It runs between the superior oblique and medial rectus muscles to enter the anterior ethmoidal foramen located 20 mm behind the orbital margin. The posterior ethmoidal territory within the nasal cavity is thought to be rather marginal compared to the anterior ethmoidal territory ( Caliot et al., 1995 ). However, defining distinct vascular territories for either ethmoidal artery has been found to be extremely difficult ( Leblanc, 2000 ).
How to remove sella floor?
It is entered using a chisel, blunt nerve hook, or drill after verification of the midline. The bony removal is widened using a 1- or 2-mm Kerrison punch or a drill to reach the planum above, the optic canals superolaterally, and the bilateral cavernous sinuses laterally. Extended transsphenoidal approaches also may involve removal of the posterior planum sphenoidale, tuberculum sellae, or portions of the clivus. The surgeon tailors the operative approach to address tumors with suprasellar, anterior cranial base, or posterior fossa extension. 113-115
What happens after anterior sphenoidotomy?
Once the anterior sphenoidotomy is completed, small amounts of bleeding originating from the edges of the sphenoidotomy must carefully be checked to avoid obscuring the lens of the endoscope during the next phases.
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The sphenopalatine artery is a branch of the maxillary artery which passes through the sphenopalatine foramen into the cavity of the nose, at the back part of the superior meatus. Here it gives off its posterior lateral nasal branches.
Crossing the under surface of the sphenoid, the sphenopalatine artery ends on the nasal septum as the posterior septal branches. Here it will anastomose with the branches of the greater palatine ar…
Notes
The sphenopalatine artery is the artery responsible for the most serious, posterior nosebleeds (also known as epistaxis). It can be ligated surgically or blocked under image guidance with minimally invasive techniques by interventional radiologist using tiny microparticles to control such nosebleeds.