Anatomical variability of the sphenopalatine artery region

Abstract

The aim of this study was anatomical description of sphenopalatine foramen region during endoscopic dissection on cadaveric specimen and modification of endoscopic approach to the sphenopalatine artery and its variable branches. Special attention was dedicated to find stable anatomical landmarks, allowing surgeon to orientate in such complex region. Every dissection was performed transnasally endoscopically in a submucoperiosteal fassion. Following anatomical structures were estimated: Presense and structure of palatal bone perpendicular plate ethmoidal crest (crista ethmoidalis). Location and shape of shpenopalatine foramen (SPF), containing sphenopalatine vasculonervous bundle. Presense and location of accessory foramen (foramen accessorium). Amount and location of sphenopalatine artery (SPA) branches. ResultsEthmoidal crest of different size and shape appeared in 100% cases, in most cases anteriorly from the sphenopalatine foramen. Sphenopalatine foramen appeared to localize on the boundery between middle and inferior meata in 87%, ethmoidal crest assumed as a border, partially dividing the foramen. Second most often location of SPF was superior meatus (13%), in these cases ethmodial crest located anteriorly from the SPF.In 35 of 60 cases (58,3%) sphenopalatine artery appeared as a single vessel, running through the SPF. In 11 cases (18,3%) 2 branches revealed in SPF, in 14 cases (23,3%) – 3 branches. Herewith the biggest branch located just behind the ethmoidal crest, and accessory branches – in the superior meatus, posteriorly to it.Knowledge of the sphenopalatine artery region anatomical variability will improve endoscopic surgical procedure effectiveness in cases of nasal cavity tumours and posterior epistaxis surgery.