The surgical steps of endoscopic sphenopalatine artery ligation. It is colloquially know as the artery of epistaxis given its common involvement in cases of nose bleeds. Transantral ligation of the maxillary artery was first reported by seiffert in 19289\ and popula rized by chandler and serrins in the 1960s1. Ligation of ethmoid artery ligation of ethmoid artery procedure hide descriptions.
So if you are looking to learn the latest surgical procedures or share your latest surgical knowledge, feel free to browse, learn, share and discuss all for free. Arterial ligation or embolization is then the secondlast resort. Health, general arteries medical examination nosebleed case studies. Get your team aligned with all the tools you need on one secure, reliable video platform. Endoscopic sphenopalatine artery ligation csurgeries. It provides 90% of the blood supply to the nasal cavity i. Endoscopic ligation of left anterior ethmoidal artery. A critical audit of the surgical management of intractable. Endoscopic sphenopalatine artery ligation hns preferences. Sphenopalatine artery ligation under local anesthesia.
When youre left without a definite cpt code to describe the procedure, you should look at. Endoscopic ligation of left anterior ethmoidal artery video. Surgery theater, with more than 12,000 educational surgery videos, is the worlds first online social medical video sharing for all health care professionals. Endoscopic sphenopalatine artery ligation pro vides a safe and effective alternative to transantral ligation of the internal maxillary artery or endovascular emboliza tion, and has become the authors treatment of choice for persistent posterior epistaxis. 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. Endoscopic sphenopalatine artery ligation is an effective method of treatment for posterior epistaxis. Snomed ct browser uk snomed ct clinical edition nhs data migration april 2020. This pdf is available for free download from a site hosted by medknow. Mistaken ligation of the right renal artery bioline international.
Ppt epistaxis powerpoint presentation free to download. This is endoscopic ligation of spa sphenopalatine artery by sinusvideos on vimeo, the home for high quality videos and the people who love them. I dont see a cpt code for this procedure can i use 30920. This video was given to the jlo website by dr mark samaha, assistant professor in the department of otolaryngology at mcgill university, montreal, canada. Oct 31, 2007 epistaxis is the most common emergency presenting to the ent surgeon. Houser rhinologyallergy otolaryngology or ear, nose, throat at metrohealth medical center 16,666 views. Endoscopic sphenopalatine artery ligation karenzupko. How is arterial ligation performed on the external carotid. Sphenopalatine artery definition of sphenopalatine artery. This web page is an entry point to find 03ln4cz icd10 code mapping to icd9. Nov 25, 2012 artery ligation for epistaxis duration. Endovascular treatment of epistaxis american journal of.
A cadaver anatomic study article pdf available in otolaryngology head and neck surgery 1453. 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. Aug 31, 2010 endoscopic ligation of sphenopalatine artery anatomy. Sphenopalatine artery ligation and vidian neurectomy ento key. Epistaxis is a common condition that can be managed conservatively in most cases. Endoscopic sphenopalatine artery ligation and embolisation had similar success rates 73100 per cent and 7592. We have performed endoscopic cauterization of nine sphenopalatine. Pdf analysis of endoscopic sphenopalatine artery surgery. During a massive pelvic hemorrhage or peripartum bleeding, bilateral ligation of the iia reduces the pelvic arterial blood flow by 49% and pulse. I did an endoscopic ligation of the left sphenopalatine artery for recurrent epistaxis in a patient with coumadininduced coagulopathy. Endoscopic sphenopalatine artery ligation espal is the intervention of choice for refractory epistaxis in specialist ear, nose and. An instructional video on the surgical technique of a sphenopalatine artery ligation.
A 58yearold female on plavix presented to the er with recurrent leftsided epistaxis after two prior endoscopic control of epistaxis at an outside hospital. The management of epistaxis is a remarkably common and particularly vexing problem for the otolaryngologist. Anterior ethmoidal artery ligation is considered for continued epistaxis uncontrolled by other means. Sep 11, 2019 a 58yearold female on plavix presented to the er with recurrent leftsided epistaxis after two prior endoscopic control of epistaxis at an outside hospital. Intractable posterior epistaxis remains a challenging problem for our specialty conventional management options in the form of anterior and posterior packing, arterial ligation of the internal maxillary or the external carotid artery and embolization, are not entively satisfactory because of morbidity, high failure rates, and occasional significant complication. However recently ligation of the sphenopalatine artery endoscopically endonasally, as the.
A series of images showing steps in ligating the right sphenopalatine artery endoscopically, transnasal. Given the unilateral presentation, antiplatelet therapy, and recently failed endoscopic control, the patient was taken. The bleeding originates from the posterior nasal cavity of the posterior ethmoid artery or a branch of the sphenopalatine artery. Please feel free to provide you feedback and suggestions. An endoscopic transnasal approach for ligation of the terminal branch of the internal maxillary artery, the sphenopalatine artery, provides an alternative to transantral ligation. Sphenopalatine artery ligation and vidian neurectomy. Article information, pdf download for sphenopalatine artery ligation for.
Conventional management options in the form of anterior and posterior packing, arterial ligation of the internal maxillary or the external carotid artery and embolization, are not entirely satisfactory because of morbidity, high failure rates and occasional significant complication. It was performed endoscopic endonasal approach to the pterygopalatine fossa and ligation of the artery inside the pterygopalatine fossa for a proximal control. Endoscopic sphenopalatine artery ligation surgery video. Over the last decade endoscopic sphenopalatine artery spa ligation has become a popular treatment option for posterior epistaxis and has been shown to be the most effective and costefficient definitive treatment for posterior epistaxis. Sphenopalatine artery an overview sciencedirect topics. We describe a multidisciplinary approach to gt and the use of sphenopalatine artery spa ligation to treat intractable epistaxis. It is a major contributor to the rich arterial plexus known as kiesselbachs plexus on the anteroinferior nasal septum. This traditionally used to involve internal maxillary artery ligation via a caldwellluc approach or ligating the external carotid artery in the neck pritikin et al. Sphenopalatine artery ligation for lifethreatening. Other invasive options for refractory epistaxis are anterior ethmoid artery ligation and embolization of the internal maxillary artery by neurointerventional radiology. Anterior ethmoidal artery ligation iowa head and neck protocols.
Within the emergency department setting, between 0. The above management is associated with significant patient complication and morbidity. The spa is situated in the posterior region of the nasal cavity, and is involved in most severe epistaxis episodes 1,2. A 4yearold filipino girl was diagnosed with gt at 1 year of age. As such, this is branch is unable to be addressed by embolization techniques. 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. It is for this reason that other workers have advocated bilateral ligation of the internal iliac arteries to significantly improve the chances of reducing pelvic pulse. To control the nose bleed, the otolaryngologist decides to perform an endoscopic transnasal sphenopalatine artery ligation.
Transantral ligation of the maxillary artery for refractory. Many epistaxis protocols now include endoscopic sphenopalatine artery ligation for bleeding that is refractory to packing. 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. Given the unilateral presentation, antiplatelet therapy, and recently failed endoscopic control, the patient was taken to the operating room. Over the last decade endoscopic sphenopalatine artery spa ligation has become a popular treatment option for posterior epistaxis and. 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. Most professional coders use to recommend 30999 or 31299, but using these codes are also found to be controversial due to. Intractable posterior epistaxis remains a challenging problem for our specialty. Post jobs, find pros, and collaborate commission free in our professional marketplace. A horizontal skin incision is made between the hyoid bone and the superior border. Endoscopic cauterization of the sphenopalatine artery in. Ligation of ethmoid artery procedure see more descriptions. Endoscopic sphenopalatine artery ligation for refractory. 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.
Elective sphenopalatine artery ligation for recurrent epistaxis. Jan 29, 2010 the decision was therefore made to perform both sphenopalatine artery spa and anterior ethmoidal artery ligation. Over the last decade endoscopic sphenopalatine artery spa ligation has become a popular treatment. Physiology of internal iliac artery ligation burchell. Endoscopic sphenopalatine artery ligation sciencedirect. Endoscopic ligation or cauterization of the sphenopalatine artery has emerged as a viable and minimally invasive alternative. In the past, the most common approach to access the end artery of the lateral nasal wall was through the posterior wall of the maxillary sinus, using a caldwellluc approach.
On investigation the epistaxis was determined to arise from an anastamosis with the contralateral sphenopalatine artery. 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. Sphenopalatine artery definition of sphenopalatine. He had facial trauma and fracture of the posterior of the maxillary sinus and the palatine bone. Ligation of the external carotid artery eca can be performed with the patient under local or general anesthesia. There is a 60% lifetime incidence of epistaxis and, among this group, 6% will seek medical attention. 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. Examples of this include endoscopic sphenopalatine artery ligation. Endoscopic ligation of the sphenopalatine artery as a.
The main source of blood in the nasal cavity is the sphenopalatine artery spa, a branch of the external carotid system. 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. Worlds best powerpoint templates crystalgraphics offers more powerpoint templates than anyone else in the world, with over 4 million to choose from. Here it gives off its posterior lateral nasal branches. Endoscopic sphenopalatine artery ligation surgery video ent. This clip shows a ligation of left anterior ethmoidal artery after failed ligation of internal maxillary artery. Endoscopic ligation of the sphenopalatine artery as a primary management of severe posterior epistaxis in patients with coagulopathy. Objectivesphenopalatine artery ligation is a commonly employed. Stepbystep ligation of the internal iliac artery ncbi. Sphenopalatine artery synonyms, sphenopalatine artery. Sphenopalatine artey cauterization for refractory epistaxis. Epistaxis is the commonest emergency in otorhinolaryngology. With the advent of the endoscope, many traditionally open procedures are now being performed endoscopically rather than via the open approach. Please use this page as a starting point for further drilling down and researching.
Endoscopic sphenopalatine artery ligation is an effective. Endoscopic ligation of the sphenopalatine artery as a primary. No, youll need to use an unlisted code such as 30999. 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. Endoscopic ligation of sphenopalatine artery picture. Winner of the standing ovation award for best powerpoint templates from presentations magazine. Ligation of the anterior ethmoidal artery is commonly performed in patients with a history of trauma. This pdf is available for free download from a site hosted by medknow publications. Synonyms for sphenopalatine artery in free thesaurus. Management of hemorrhagic pseudoaneurysmal arteriovenous. On investigation the epistaxis was determined to arise from an anastamosis with the contralateral sphenopalatine. Endoscopic sphenopalatine artery ligation is an effective method of. Click to complete our 2minute survey and help us improve the quality of our website and videos.
Sphenopalatine definition of sphenopalatine by medical. Diagram showing the distribution of nerve and arterial branches medial and lateral to the sphenopalatine foramen after janfaza et al. There was no family history of bleeding disorders or blood dyscrasias. Anatomy of the sphenopalatine artery inferior turbinate the sphenopalatine artery spa is one of the terminal branches of the internal maxillary artery ima which originates from the external carotid artery system. Ligation of the internal maxillary artery ima has its own considerable failure rate 10%, as well as an associated morbidity 14,26,27. 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. Elective sphenopalatine artery ligation for recurrent. The patients hemoglobin and hematocrit at presentation were 8. Epistaxis may be classified clinically into anterior and posterior bleeds. Failure rates in cauterizing or ligating the spa in severe nosebleeds range between 2% to 10% 3. Endoscopic ligation of spa sphenopalatine artery on vimeo. Anterior ethmoidal artery ligation iowa head and neck. We have used endoscopic ligation of the sphenopalatine artery to treat 38 patients requiring surgical therapy for epistaxis. Patient with recurrent epistaxis after the nasal packing was removed.
Maxillary artery ligation for severe idiopathic epistaxis is a valid procedure only if injury to the infraorbital nerve is avoided. External carotid artery was ligated in seven patients. Endoscopic cauterization of the sphenopalatine artery to. Jun 15, 2016 failure of the transantral ligation was thought to be the result of extensive collateral blood flow supplying the sphenopalatine artery distal to the site of ligation as well as the difficulty in ligating all of the multiple and varied branches of the vasculature within the pterygopalatine fossa. Find your way through the maze of sphenopalatine artery. Endoscopic sphenopalatine artery ligation in posterior.
488 1212 999 1524 1304 40 518 1355 795 1313 220 362 436 1389 782 536 1263 504 808 1583 277 1287 1278 538 1348 1122 758 883 1487