Applied Anatomy Of The Sphenopalatine Artery And Ethmoidal Artery

ObjectiveThrough observing the location of the sphenopalatine foramen and the piercingpoints of sphenopalatine artery branches on the lateral nasal wall, to assess the shortageof the traditional middle meatus approach for the ligation of sphenopalatine artery.Through observing the distribution of posterior lateral nasal artery on the lateral nasalwall, to discuss the feasibility of the inferior turbinate artery electrocoagulation.Through analyzing the anatomical and clinical data of anterior ethmoidal artery toexplore an alternative way of ligation.Materials and Methods1.50cases of dry hemi-skull.16cases of head specimens,of which12cases wereanti-corrosion specimen,4cases were four fresh specimen. Clinical data (CT Image,Nasal endoscopy Image).2. Observe the location of the sphenopalatine foramen on50cases of dryhemi-skull. Measure the relevant data of the sphenopalatine foramen.measure thedistance between anterior ethmoidal foramen and anterior nasal spine, and the anglebetween the connective line and the base of the nose.3.15cases anti-corrosion and fresh head specimens were perfused with red latex,of which10cases cut in the middle sagittal section,5cases were coronally cut at theposterior end plane of middle turbinate. One fresh head specimen was used for castspecimens.4. Dissect the lateral nasal wall on20sides of the middle sagittal section heads,measure the distances between the piercing points of sphenopalatine artery branches and some anatomic landmarks: the horizontal attachment and posterior tip of middleturbinate，maxillary sinus apertura, Choanal. Observe the distribution of PLNA on thelateral wall of middle meatus, measure the distances between the origin of inferiorturbinate artery and some anatomic landmarks. On5coronally section heads, measurethe distances between sphenoid sinus apertura and superior and inferior branch ofPLNA. Open the orbital roof and the ethmoid roof. Fully demonstrate the course ofAnterior ethmoid artery.5. Observe the course of the main branchs of sphenopalatine artery and anteriorethmoid artery stem on cast specimens.6. Analyze clinical data (CT Image, Nasal endoscopy Image).Results1. The location of the sphenopalatine foramen: the first type,the SPF was lacatedat the transition area of posterior part of middle and superior meatus,accounts for76%;the second type, the SPF was lacated posterosuperior to the middle meatus,accounts for24%. relevant data of the sphenopalatine foramen:the distance betweenethmoidal crest and anterior nasal spine:54.15±7.82(mm)；the angle between theconnective line and the base of the nose:(21.4±3.6)°; the vertical distance betweenethmoidal crest and the horizontal part of the inferior turbinate:13.11±2.12mm; thevertical distance between ethmoidal crest and base of nose:18.27±1.13mm.2. Relevant data of the piercing points of sphenopalatine artery branches. Distanceof the piercing point of PLNA to maxillary sinus apertura:21.60±3.03mm; to Choana:9.41±2.05mm; to the posterior end of middle turbinate:8.21±1.74mm. The piercingpoint of PSA to the horizontal attachment of middle turbinate:4.31±1.69mm and to theposterior attachment of middle turbinate,vertical distance:8.21±1.74mm; horizontaldistance:7.72±2.04mm. Relative to the horizontal attachment of middle turbinate, thepiercing points of PSA always locate posterosuperior to it. The distances betweensphenoid sinus apertura and superior、inferior branch of PSA on the anterior wall of sphenoid sinus：8.50±0.20mm、13.22±0.30mm. The diameter of the superior、inferiorbranch is0.93±0.06mm、1.01±0.21mm, respectively.3. In95%of the specimen, the PLNA is devided into two branches, ITB and MTB,only in one case,there are two ITB.The ramification level can be devided into two type:proximal ramification(95%); distal ramification(5%). In12cases, the fontanel branchcan be seen, it originate from MTB in10cases, originate from ITB in2cases. In3cases we find a desending palatine artery branch course forward to join ITB. Thevertical distance from the origin of ITB to the attachment of MT is2.50±1.22mm;Thevertical distance from the origin of ITB to the attachment of IT is9.50±2.10mm;Thedistance from the origin of ITB to the posterior attachment of MT is8.21±2.80mm,The horizontal distance between the origin of ITB and the posterior attachment of ITBis9.20±1.82mm. The distance from the origin of ITB to the ostium of maxillary sinusis20.22±3.01mm.4. Anterior ethmoidal artery pass through three chamber: orbit, ethmoid sinus,anterior cranial fossa. It was located in the ethmoid sinus in a horizontal position,andrunning forward in anteromedial derection.Then penetrate the nasal cavity in the frontpart of the olfactory fossa. The ethmoidal portion sometime is very close to theethmoidal roof, sometime is not. the distance between anterior ethmoidal foramen andanterior nasal spine is58.13±4.01mm; and the angle between the connective line andthe base of the nose is (65.5±4.5)°.Conclusion:1. Ligate of the sphenopalatine artery through a two-step approach is analternative option.2. In order to reduce blood loss during inferior turbinate surgery, the suitablecauterization area is about1cm anterior to the posterior end of IT, close to theattachment bone of IT.3. Find and ligate the anterior ethmoidal artery in transition area of the laminapapyracea and the ethmoidal roof is a alternative approach.