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. Asanau a, timoshenko ap, vercherin p et al 2009 sphenopalatine and anterior ethmoidal artery ligation for severe epistaxis. Ligation of the external carotid artery has been historically described which is a nonspecific method of decreasing blood flow to the nose which also has frequent treatment failures thought to be due to collateral circulation from opposite external carotid artery. Management of epistaxis in patients with ventricular. Role of endoscopic internal maxillary artery ligation in. However, in our study, no patient reported any of these complications.
Sphenopalatine artery definition of sphenopalatine. Microsurgical ligation of the sphenopalatine artery was introduced by prades in the 1970s. Ligation was performed using two small metal clips placed on the artery. University of tennessee health science center gross anatomy lab. Endoscopic sphenopalatine artery ligation for refractory. Ligation of the carotid artery for intractable epistaxis was first reported by pilz in 1869 performed on the common carotid artery in this case. Sphenopalatine artery ligation is a commonly employed surgical intervention for control of posterior epistaxis unresponsive to nasal packing. The most frequent location of the sphenopalatine foramen was in the transition between the middle and superior meatus. Pdf endoscopic ligation of the anterior ethmoidal artery. Transnasal endoscopic sphenopalatine artery ligation tespal has been the treatment of choice for idiopathic intractable epistaxis.
Endoscopic cauterization of the sphenopalatine artery to. What is the evidence for sphenopalatine artery ligation. It provides 90% of the blood supply to the nasal cavity i. Endoscopic sphenopalatine artery ligation or diathermy. All patients had epistaxis refractory to anterior and posterior nasal packing, which was rapidly controlled following the procedure.
This study sought to characterize the clinical features and. Generally the ligation of external carotid artery is considered a last resort in. Other invasive options for refractory epistaxis are anterior ethmoid artery ligation and embolization of the internal maxillary artery by neurointerventional radiology. This video depicts the endoscopic ligation of the sphenopalatine artery for control of bleeding during sinus surgery or epistaxis nosebleeds. Objectivesphenopalatine artery ligation is a commonly employed. If tespal fails, transantral ligation of internal maxillary artery ima used to be the dictum along with. Aug 31, 2010 crista ethmoidalis serves as landmark just anterior to sphenopalatine foramen. Ligation of the sphenopalatine artery in posterior epistaxis.
No, youll need to use an unlisted code such as 30999. The sphenopalatine artery bjorl brazilian journal of. Epistaxis, or nasal bleeding, is a common occurrence and has been reported in up to 60 percent of the population. Consider endoscopic sphenopalatine artery ligation in the acute management of posterior epistaxis. The objective of the present study was to evaluate the outcome of sphenopalatine artery ligation for control of epistaxis at our institution and the impact of timing and other factors on outcome. Importance intractable epistaxis is a common otolaryngology emergency. Costeffectiveness analysis of endoscopic sphenopalatine. Endoscopic sphenopalatine artery ligation in posterior. In many instances it is minor or selflimiting and persons do not seek medical treatment. Endoscopic sphenopalatine artery ligation hns preferences. This procedure is associated with low complication rates7. I did an endoscopic ligation of the left sphenopalatine artery for recurrent epistaxis in a patient with coumadininduced coagulopathy. We describe a multidisciplinary approach to gt and the use of sphenopalatine artery spa ligation to treat intractable epistaxis.
Oxidized regenerated cellulose was placed at the sphenopalatine foramen, and the flap was replaced. However, a single intervention is yet to provide definitive treatment. Abstractintroduction epistaxis is one of the most common medical emergencies, making. Analysis of endoscopic sphenopalatine artery surgery for. We report our experience of elspa in patients with a mean followup of months. Houser rhinologyallergy otolaryngology or ear, nose, throat at metrohealth medical center 16,666 views. Sphenopalatineinternal maxillary artery ligation sciencedirect. A total of 896 cases of sphenopalatine ligation or cauterization for epistaxis were analyzed. Endoscopic sphenopalatine artery ligation is an effective method of. Endoscopic sphenopalatine artery ligation karenzupko. 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. It is colloquially know as the artery of epistaxis given its common involvement in cases of nose bleeds. The sphenopalatine artery is the terminal branch of the maxillary artery and enters the nasal cavity through the sphenopalatine foramen, which is located behind the end of the middle turbinate corresponding to the inferolateral corner of the sphenoidal sinus fig. Endoscopic ligation of the anterior ethmoidal artery.
Endoscopic nasal surgery, with cauterization or ligation of the sphenopalatine artery on its entry into the nasal cavity, has been shown to be effective and minimally invasive in treating and controlling intractable epistaxis fig. Sphenopalatine artery ligation and vidian neurectomy. The aaohns had previously requested that this code by removed from the ipo list, and thus fully supported the agencys proposal. Endovascular treatment of epistaxis american journal of. Hyde 1 reported a case of what he terms idiopathic nasal hemorrhage which was ultimately controlled by ligation of the external carotid artery. We suggest that this operative procedure be considered early in the treatment of refractory epistaxis. Steed, in current therapy in oral and maxillofacial surgery, 2012. Endoscopic cauterization of the sphenopalatine artery in. Endoscopic ligation of the sphenopalatine artery as a. Pdf endoscopic endonasal ligation of the sphenopalatine artery. There are no contraindications for spa cauterization. Pdf endoscopic endonasal ligation of the sphenopalatine.
Sphenopalatine artery ligation and vidian neurectomy ento key. Our experience with endoscopic sphenopalatine artery ligation for four patients with posterior epistaxis is described. Methods the mucosa on the sphenopalatine foramen and its surrounding mucosa were removed with a microscissors, a fine forceps, and a pick to expose the sphenopalatine artery under an operating microscope original magnification. Rudresh k b reader dept of oral and maxillofacial surgery presented by dr. Sphenopalatine artery ligation for lifethreatening. Endoscopic sphenopalatine artery ligation has become the standard surgical therapy for posterior epistaxis refractory to nasal. The aaohns appreciates cms consideration of our input in finalizing the removal of cpt code 31241 from. Endoscopic ligation of the sphenopalatine artery as a primary. This web page is an entry point to find 03ln4cz icd10 code mapping to icd9. Patients with a ventricular assist device vad are at risk for epistaxis due to the need for anticoagulation. The aim of this study was to evaluate the efficacy of endoscopic ligation of the sphenopalatine artery in the treatment of severe posterior epistaxis.
Epistaxis is the most common emergency presenting to the ent surgeon. Prospective anatomic study from november to december 2009. A representative example of the sphenopalatine artery is shown in fig. 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. The above management is associated with significant patient complication and morbidity. Article information, pdf download for sphenopalatine artery ligation for. When these measures, including anterior and posterior packing of the nasal cavity, are unsuccessful at controlling the bleeding, interruption of the blood supply to the sinonasal area can be performed, either by surgical ligation or by transarterial embolization. We have performed endoscopic cauterization of nine sphenopalatine.
Nov 25, 2012 artery ligation for epistaxis duration. Sphenopalatine artery definition of sphenopalatine artery. An instructional video on the surgical technique of a sphenopalatine artery ligation. Transantral ligation of the maxillary artery was first reported by seiffert in 19289\ and popula rized by chandler and serrins in the 1960s1. The protocols for managing intractable idiopathic epistaxis have evolved with advances in endoscopic techniques. Endoscopic ligation of maxillary and sphenopalatine artery. The ethmoidal spine is an important anatomic landmark, as it is present in almost all cases in a position anterior to the sphenopalatine foramen. The surgical steps of endoscopic sphenopalatine artery ligation. Abstractknowledge on the anatomy of the sphenopalatine artery spa and its branches is fundamental for the success of the endoscopic treatment of posterior epistaxis. Sphenopalatine artery ligation for lifethreatening epistaxis. Ligation of the sphenopalatine artery in posterior. This study aimed to determine the safety and efficacy of sphenopalatine artery spa surgery in patients with refractory epistaxis and to identify factors associated with the indications for surgery to assist clinicians in making prompt and appropriate decisions regarding spa surgery for refractory epistaxis. Cauterization was performed using an active device for ultrasonic treatment.
Jun 08, 2012 also palatal numbness was reported in % of cases. Ligation or cauterization was performed at the surgeons discretion. Oct 31, 2007 traditionally, posterior epistaxis has been managed with a sequence of nasal packing, smr, septoplasty, anterior ethmoid ligation, sphenopalatine artery ligation, transantral maxillary artery ligation, selective maxillary artery embolization and external carotid artery ligation. Pooled rebleeding and complication rates were calculated by using a random effects model. Ligation of the anterior ethmoidal artery is commonly performed in patients with a history of trauma. The optimal surgical management for failed conservative measures in epistaxis remains unclear. This technique appears to be a safe and effective surgical treatment for patients with intractable epistaxis. An endoscopic transnasal approach for ligation of the terminal branch of the internal maxillary artery, the sphenopalatine artery, provides an alternative to transantral ligation. We have carried out a retrospective study on 50 patients hospitalised with posterior recurrent epistaxis, in whom posterior nasal packing was not effective. Endscopic ligation of the maxillary and sphenopalatine arteries is safer than intraarterial embolization and less invasive than conventional surgical approach for the ligation of maxillary artery. I dont see a cpt code for this procedure can i use 30920.
Figure 1 a computerized tomography ct scan of patient 1, which reveals a fracture of the left orbital floor circled together will multiple undisplaced nasal fractures. On investigation the epistaxis was determined to arise from an anastamosis with the contralateral sphenopalatine. Our experience with endoscopic sphenopalatine artery ligation for four patients with posterior existaxis is described. Introduction bleeding from nostril, nasal cavity or nasopharynx most often self limited, but can often be serious and life threatening 510% of the population experience an episode of epistaxis each year, 10% of those will seek a physician and 1% of those will need a specialist can occur in all age groups. Endoscopic cauterization of the sphenopalatine artery causes interruption of the nasal vasculature at a point distal enough to prevent direct, retrograde and anastomotic blood flow. Please use this page as a starting point for further drilling down and researching. The approach used for the ppf biopsy in 2 patients in our series cases 2 and 3 first identifies the sphenopalatine foramen medially, similar to the approach used for sphenopalatine artery ligation for epistaxis. A closure by ligation or diathermy of the sphenopalatine artery prevents direct retrograde and. Given the growing enthusiasm for endoscopic transnasal sphenopalatine artery ligation, it is prudent and timely to evaluate the evidence base for this technique.
Crista ethmoidalis serves as landmark just anterior to sphenopalatine foramen. The sphenopalatine artery nasopalatine artery is an artery of the head, commonly known as the artery of epistaxis. Endoscopic ligation of sphenopalatine artery anatomy. Pdf analysis of endoscopic sphenopalatine artery surgery. The maxillary artery and its terminal branches supply the posterior and inferior parts of the nasal cavi ty, and ligation of these specific vessels may result. We systematically searched electronic databases and identified articles regarding epistaxis, sphenopalatine artery ligation, or cauterization. Evaluation of etiology and treatment methods for epistaxis. Pdf internal maxillary artery ligation for persistent posterior epistaxis is traditionally performed via the transantral approach. Endoscopic ligation or cauterization of the sphenopalatine artery has emerged as a viable and minimally invasive alternative. Endoscopic ligation of the sphenopalatine artery elspa is emerging as a minimally invasive alternative. Endoscopic transnasal approach to the pterygopalatine fossa. Transnasal endoscopic sphenopalatine artery ligation tespal and endovascular arterial embolization both provide excellent success rates, and therefore the decision to choose one over the other can be challenging. It is a nonspecific method of decreasing blood flow to the nose and, studies.
There are, however, many reports of the ligation of the common carotid artery. Elective sphenopalatine artery ligation for recurrent. 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. Sphenopalatine artery ligation under local anesthesia. Sphenopalatine artery synonyms, sphenopalatine artery. Endoscopic ligation of spa sphenopalatine artery youtube. Epistaxis was controlled in 92% and to date no complications. The anatomy of the sphenopalatine artery is highly variable. To clarify endoscopic anatomy of the sphenopalatine artery spa in relation to intranasal endoscopic landmarks using a human cadaver model and to simplify the surgical approach to spa ligation. This article is from iranian journal of otorhinolaryngology, volume 25. Nov 23, 20 endoscopic sphenopalatine artery ligation espal. Sphenopalatine artery ligation has been shown to be associated with a shorter hospital stay and cost effectiveness compared with other surgical modalities.
Results the feeding vessels of the superior turbinate were from the septal artery in 36 cases 72%. Transantral ligation of the maxillary artery for refractory. Sphenopalatine artery surgery for refractory idiopathic. Epistaxis may be classified clinically into anterior and posterior bleeds. Arterial supply of head and neck linkedin slideshare. Endoscopic sphenopalatine artery ligation espal for acute epistaxis has been investigated extensively and it provides a low morbidity, costeffective alternative to prolonged posterior nasal packing and inpatient stay, internal maxillary artery ima ligation or arterial embolization. Synonyms for sphenopalatine artery in free thesaurus. Sphenopalatine artery an overview sciencedirect topics. Sphenopalatine artey cauterization for refractory epistaxis. Here we present a case of epistaxis arising from the sphenopalatine artery in a patient who had previously had the ipsilateral external carotid artery ligated due to previous epistaxis. Please feel free to provide you feedback and suggestions. Endoscopic monopolar cauterization of the sphenopalatine. Endoscopic clip appliers facilitate clip application. Endoscopic sphenopalatine artery ligation and embolisation had similar success rates 73100 per cent and 7592 per cent, respectively, although embolisation was.
The technique of sphenopalatine artery ligation is described. In 75 cadaveric specimens, simmen showed that in 97% of the samples the sphenopalatine artery had 2 or more branches exiting the lateral nasal wall, 67% had 3 or more branches, 35% had 4 or more branches, 3% had 1 single trunk and 1% had 10 branches 7. This short video demonstrates their technique for dividing the sphenopalatine artery spa in the management of refractory. Prades was the first to describe sphenopalatine artery ligation through a middle meatus antrostomy for dividing the vidian nerve using the surgical microscope in 1976. We have used endoscopic ligation of the sphenopalatine artery to treat 38 patients requiring surgical therapy for epistaxis. There was no family history of bleeding disorders or blood dyscrasias. Epistaxis is a common condition that can be managed conservatively in most cases. Many epistaxis protocols now include endoscopic sphenopalatine artery ligation for bleeding that is refractory to packing. Spa may branch prior to exiting foramen, often with larger spa branch and smaller posterior nasal branch.
Endoscopic localization of the sphenopalatine foramen. It is superior to posterior nasal packing and embolization when it comes to pain, costeffectiveness, risk, and overall control of bleeding. Elective sphenopalatine artery ligation for recurrent epistaxis. Avinash rathore post graduate dept slideshare uses cookies to improve functionality and performance, and to. Endoscopic endonasal ligation of the sphenopalatine artery article pdf available in rhinology 383. Jan 29, 2010 the decision was therefore made to perform both sphenopalatine artery spa and anterior ethmoidal artery ligation. Management is complicated by the risk of thrombosis if anticoagulation is reversed. It is a major contributor to the rich arterial plexus known as kiesselbachs plexus on the anteroinferior nasal septum. A 4yearold filipino girl was diagnosed with gt at 1 year of age. This procedure, however, is associated with significant morbidity. Management of hemorrhagic pseudoaneurysmal arteriovenous.