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 ...
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 artery is identified with a maxillary antrostomy?
Make a large maxillary antrostomy to identify the sphenopalatine artery and the posterior nasal artery.
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.
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 supplies the nasal fossa?
A branch of the internal carotid artery, the ophthalmic artery, supplies the nasal fossa through the anterior and posterior ethmoidal arteries.
Which artery supplies the anterior portion of the septum and medial wall of the nasal vestibule?
The superior labial artery , arising from the facial artery, penetrates the orbicularis oris muscle at the level of the commissure and enters into the nasal osteum superficial to the depressor septi nasi muscle. It supplies the anterior portion of the septum and medial wall of the nasal vestibule through the septal branch.
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 ...
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 artery is identified with a maxillary antrostomy?
Make a large maxillary antrostomy to identify the sphenopalatine artery and the posterior nasal artery.
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.
Which artery supplies the nasal fossa?
A branch of the internal carotid artery, the ophthalmic artery, supplies the nasal fossa through the anterior and posterior ethmoidal arteries.
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 penetrates the orbicularis oris muscle?
The superior labial artery, arising from the facial artery, penetrates the orbicularis oris muscle at the level of the commissure and enters into the nasal osteum superficial to the depressor septi nasi muscle. It supplies the anterior portion of the septum and medial wall of the nasal vestibule through the septal branch.
Where do the major palatine arteries originate?
The major and minor palatine, sphenopalatine and infraorbital arteries originate from the maxillary artery. The malar artery originates from the infraorbital artery. The facial artery originates from the external carotid artery ( Fig. 45.1). The greater palatine foramen is located at a level approximately equal to the distal surface of the maxillary fourth premolar tooth and midway between the palate midline and dental arch. The major palatine artery, vein and nerve exit this foramen, and course along the length of the palate in the palatine sulcus. The palatine sulcus is located halfway between the midline and dental arch, making it relatively easy to find and ligate the major palatine vessels. The artery enters the nasal cavity through the palatine fissure as the rostral septal branch of the nasal septum. At the level of the palatine fissure an arterial branch originates from the major palatine artery and courses on the palate through the interdental space between the canine and third incisor teeth to terminate on the lateral aspect of the incisive bone. This artery may be transected during incisivectomy (‘premaxillectomy’) techniques. 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. The lateral nasal artery anastomoses with the superior labial branch of the facial artery. These arteries provide the blood supply to the vestibular mucosal–submucosal flaps commonly used to close maxillectomy defects. Terminal branches of the malar artery may be encountered during partial orbitectomy.
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 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 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.
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.
Where are the sensory neurons located?
The human olfactory epithelium in the upper nasal cavity har bors 6-10 million olfactory sensory neurons. Each bipolar neuron located within the nasal mucosa sends a single dendrite with 20-30 cilia to reach the surface for odor perception ( Firestein, 2001). Their axons ascend as fila olfactoria through the cribriform plate to form synaptic connections in the olfactory bulb located in the olfactory sulcus of the ethmoid bone. The superior nasal cavity mucosa and the olfactory neurons are supplied by a rich arterial network fed by the sphenopalatine artery and the anterior and posterior ethmoidal arteries (Bartholdy, 1897; Osborn, 1978 ). The sphenopalatine artery arises from the pterygopalatine segment of the maxillary artery. Within the pterygopalatine fossa, the artery passes through the sphenopalatine foramen to reach the upper nasal cavity behind and slightly above the middle nasal concha. There, major branches, the posterior lateral nasal and nasal septal arteries, form extensive ramifications ( Osborn, 1978; Prades, Asanau, Timoshenko, Faye, & Martin, 2008 ).
What is sphenopalatine artery ligation?
This technique is increasingly considered to be an essential component of training for any otolaryngologist and can greatly reduce periods of nasal packing and active bleeding for your patients and length of stay for your hospitals.#N#It is also an essential skill for any surgeon performing surgery in the nose.
Where is the sphenopalatine foramen located?
The sphenopalatine foramen is located in the nasal side wall, lateral (not inferior) to the posterior end of the middle turbinate. 2. Peer Review is pending. None so far... Points of Contention. 1. Division vs. Non-division. Even within the authors, there is disagreement. The arguments for division is that by dividing and visualising beyond ...
Where is the foramen located?
Foramen is located inferiorly to the posterior end of the middle turbinate (incorrect - see corrections). The second anatomical landmark is posterior membranous fontanelle of the maxillary sinus, which can be palpated using curved suction. Foramen is located posteriorly to the fontanelle.
Can you cauterize sphenopalatine artery?
Here you can see the anatomical relations of the sphenopalatine artery again. Now you can see the cauterization of the artery with bipolar coagulation. Some authors recommend to clip the artery, but it is very difficult as the foramen sits very close to the sphenoid bone, and therefore the metal clip very often dislodges. Generally, we do not recommend a division of the artery as this can result in major bleeding in some cases later on. The Patient is usually discharged the same day if no further bleeding is noted. We often apply surgical locally Surgicel in patients who take warfarin or aspirin. There is no need for packing. Thank you for watching our video. We always emphasize that is our own technique which will almost certainly change with the time. If you feel that you have got any interesting tips or contributions, please get in touch with us through SurgTech.net.
Where do secretomotor and vasoconstrictor fibers enter the pterygopalatine?
The secretomotor and vasoconstrictor fibers then enter the pterygopalatine ganglion in the pterygopalatine fossa. The ganglion is suspended – and joined – by general sensory fibers from the maxillary branch of the trigeminal nerve (CN V2), which travels superior to the ganglion by way of foramen rotundum.
Where are the cell bodies of the parasympathetic fibers located?
The cell bodies of the parasympathetic fibers of the pterygopalatine ganglion are located in the superior salivatory nucleus of the tractus solitarius in the dorsal pons of the brain stem. The cell bodies for the taste fibers that accompany the parasympathetic fibers, as well as those of the motor fibers of the chorda tympani, ...
What is the effect of stimulation of the parasympathetic fibers of the pterygopalatine?
Stimulation of the parasympathetic fibers of the pterygopalatine ganglion has been implicated in primary headache disorders such as cluster headaches (intense , nocturnal , unilateral periorbital pain that disrupts sleep that remits every few weeks or months) and migraines (immense pulsating regional head pain associated with photosensitivity, audio sensitivity, nausea, and vomiting). Abscission or blockade of the ganglion has been successfully used to treat these pathologies.
How long does it take to read a pterygopalatine ganglion?
Reading time: 6 minutes. The pterygopalatine (sphenopalatine) ganglion is one of four small parasympathetic ganglia found in the head. It resides in the pterygopalatine fossa, which is located in the superior pterygomaxillary fissure, in the anterosuperior part of the infratemporal fossa (medial to the zygomatic arch and the coronoid process ...
What is the pterygopalatine fossa?
Pterygopalatine fossa. Pterygopalatine fossa (lateral-left view) The body of the ganglion rests in the pterygopalatine fossa . The pterygopalatine fossa is a depression that lies within the pterygomaxillary fissure, inferior to the sphenopalatine foramen. This fissure is a natural furrow that is formed between the posterosuperior border ...
Which nerves travel through the internal carotid plexus?
Postganglionic sympathetic fibers travel through the internal carotid plexus and join the greater petrosal nerve by way of the lesser (deep) petrosal nerve in foramen lacerum. Together, these nerves become the (Vidian) nerve of the pterygoid canal. The secretomotor and vasoconstrictor fibers then enter the pterygopalatine ganglion in ...
Which ganglions carry sensory nerves?
The branches of the pterygopalatine ganglion carry parasympathetic, sympathetic, and general sensory fibers to several locations by way of its six branches. The mixed nerve fibers travel through the cranial ostia to innervate the nose, palate, and nasopharynx.
