Surgical anatomy of the distal maxillary artery

Abstract

Problem: Arterial ligation of the sphenopalatine artery is a key option in the management of persistent posterior epistaxis. Coexisting with established transantral techniques are newer endoscopic transnasal methods. Knowledge of the arterial configuration allows understanding of the rationale of current treatments and assists in the interpretation of treatment failures. Methods: One hundred twenty-eight cadaveric tissue blocks containing the pterygopalatine fossae were used. One hundred eighteen blocks were dissected using a Watson-Barnet 25× dissecting microscope. Ten blocks were cleared by the Spalteholz technique after injection with latex-Indian Ink. Arterial configurations were analyzed and photographic records were made. Results: Analysis of the arteries in the pterygopalatine fossa showed 3 common configurations: a single looped form (18%) and 2 double-looped forms (51% and 31%). Terminal bifurcation of the sphenopalatine artery arose before the sphenopalatine foramen in 74.6%. In contrast to previous smaller studies, we found remarkable symmetry in the size of the maxillary arteries and a low incidence of “early” pharyngeal arteries. Conclusion: This is the most comprehensive anatomical study of the distal maxillary artery. The arterial configuration can be easily classified into 3 common forms. Some forms are more liable to lead to confusion at the time of ligation particularly if the osteotomy is inadequate. Significance: Understanding of the arterial anatomy and its variants will reduce the risk of technical failures and improve both the rationale and the reliability of ligation procedures in the treatment of epistaxis. Support: None reported.