The most frequent location of the sphenopalatine foramen was in the transition between the middle and superior meatus. Spa ligation is generally indicated for intractable posterior. Endoscopic endonasal greater palatine artery cauterization. This is the first documented case of superselective embolisation of the sphenopalatine artery on both sides to manage a case of severe traumatic epistaxis. The anatomy of the sphenopalatine artery is highly variable. The sphenopalatine artery spa, a terminal branch of the internal maxillary artery ima, supplies blood to the lateral nasal wall, inferior and middle turbinate, and the posterior septum, and is implicated in most cases of posterior epistaxis. A detailed literature search identified 11 publications relating to endoscopic sphenopalatine artery ligation.
No patient has had further epistaxis requiring medical attention. Most professional coders use to recommend 30999 or 31299, but using these codes are also found to be controversial due to. Houser rhinologyallergy otolaryngology or ear, nose, throat at metrohealth medical center 16,666 views. We have carried out a retrospective study on 50 patients hospitalised with posterior recurrent epistaxis, in. Crista ethmoidalis serves as landmark just anterior to sphenopalatine foramen. Endoscopic sphenopalatine artery ligation when, why and how to do it. The aim of this study was to evaluate the efficacy of endoscopic ligation of the sphenopalatine artery in the treatment of severe posterior epistaxis. As such, this is branch is unable to be addressed by embolization techniques. Traditionally, the initial management of posterior epistaxis involved placement of anteroposterior nasal packing and inpatient observation.
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. Surgical anatomy of the sphenopalatine artery in lateral. For persistent posterior epistaxis, the sphenopalatine artery may be ligated as the artery leaves the sphenopalatine foramen to enter the nasal mucosa of the lateral wall of the nose. Endoscopic sphenopalatine artery ligation in posterior epistaxis. 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.
It is colloquially know as the artery of epistaxis given its common involvement in cases of nose bleeds. The aaohns appreciates cms consideration of our input in finalizing the removal of cpt code 31241 from. Sphenopalatineinternal maxillary artery ligation sciencedirect. Pdf analysis of endoscopic sphenopalatine artery surgery. Transnasal endoscopic sphenopalatine artery ligation compared with embolization for intractable epistaxis. Endoscopic ligation of sphenopalatine artery anatomy. Sphenopalatine artery ligation for lifethreatening epistaxis in a 4yearold child with glanzmann thrombasthenia show all authors. Sphenopalatine artery ligation is a commonly employed surgical intervention for control of posterior epistaxis unresponsive to nasal. Endoscopic cauterization of the sphenopalatine artery in. Sphenopalatine artery an overview sciencedirect topics. We analyzed 97 consecutive patients with nasal bleeding. Another new code reports ligation of the sphenopalatine artery during a nasalsinus endoscopy.
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 ligation for lifethreatening. Endoscopic sphenopalatine artery ligation or diathermy. I did an endoscopic ligation of the left sphenopalatine artery for recurrent epistaxis in a patient with coumadininduced coagulopathy. Sphenopalatine artery cauterization epistaxis youtube.
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. A critical audit of the surgical management of intractable. As with many new procedures, it has been progressively adopted as common practice, despite a. 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. Examples of this include endoscopic sphenopalatine artery ligation. Ligation or cauterization was performed at the surgeons discretion. Those who do not stop will usually require surgical management. With the advent of the endoscope, many traditionally open procedures are now being performed endoscopically rather than via the open approach. The aaohns had previously requested that this code by removed from the ipo list, and thus fully supported the agencys proposal. Knowledge on the anatomy of the sphenopalatine artery spa and its branches is fundamental. From 2007 to 2012 17 patients were treated with cauterization andor ligature of the sphenopalatine artery with endonasal endoscopic approach. Epistaxis, or nasal bleeding, is a common occurrence and has been reported in up to 60 percent of the population. Endoscopic sphenopalatine artery ligation is widely accepted as effective and safe for acute spontaneous epistaxis that is unresponsive to conservative management. This method is commonly effective and does not cause serious consequences to patients.
The surgical steps of endoscopic sphenopalatine artery ligation. Sphenopalatine artery ligation and vidian neurectomy. Bilateral superselective sphenopalatine artery ligation effectively and safely controlled severe epistaxis in a single case of multiple facial fractures. Management of posterior epistaxis by endoscopic clipping. How is arterial ligation performed on the internal. In this study, we aimed to present the results of 30 patients who underwent transnasal endoscopic sphenopalatine artery ligation tespal for. Introduction external carotid artery is the chief artery which supplies to structures in the front of the neck and in the face 3. The sphenopalatine artery gives off two main branches.
Analysis of endoscopic sphenopalatine artery surgery for. How is arterial ligation performed on the external carotid. Endoscopic sphenopalatine artery ligation for refractory. Pdf glanzmann thrombasthenia gt is a rare autosomal recessive platelet disorder affecting chromosome 17. 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. Transnasal endoscopic sphenopalatine artery ligation tespal and endovascular arterial embolization both provide excellent success rates, and therefore the decision to choose one over the. Anterior ethmoidal artery ligation iowa head and neck. For patients with refractory epistaxis, endoscopic sphenopalatine artery ligation had the most favourable adverse effect profile and success rate compared to other forms of surgical artery.
It provides 90% of the blood supply to the nasal cavity i. An instructional video on the surgical technique of a sphenopalatine artery ligation. Costeffectiveness of endoscopic sphenopalatine artery. In 1976, prades described the ligation of the sphenopalatine artery using the. Endovascular treatment of epistaxis american journal of. The total number of patients in the pooled series was 127, of which 98% had control. The sphenopalatine artery spa is one of the terminal. However recently ligation of the sphenopalatine artery endoscopically endonasally, as the most distal feeding vessel to the nose posteriorly sharp et al. Explore 2018 changes for otolaryngology aapc knowledge. Oxidized regenerated cellulose was placed at the sphenopalatine foramen, and the flap was replaced.
During the surgical procedure, sphenopalatine artery ligation with or without anterior ethmodal artery ligation is generally performed and may be uni or bilateral. Bilateral sphenopalatine artery embolisation in panfacial. No, youll need to use an unlisted code such as 30999. The ethmoidal spine is an important anatomic landmark, as it is present in almost all cases in a position anterior to the sphenopalatine foramen. Endoscopic sphenopalatine artery ligation csurgeries. It is a major contributor to the rich arterial plexus known as kiesselbachs plexus on the anteroinferior nasal septum. Endoscopic sphenopalatine artery ligation in posterior. A horizontal skin incision is made between the hyoid bone and the superior border. Endoscopic sphenopalatine artery ligation karenzupko. Epistaxis is a common condition that can be managed conservatively in most cases. This procedure is associated with low complication rates7.
Results the feeding vessels of the superior turbinate were from the septal artery in 36 cases 72%. 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. Internal maxillary artery ligation for idiopathic intractable epistaxis j. Intractable epistaxis is a common otolaryngology emergency.
Endoscopic ligation of the sphenopalatine artery as a. Successful ligation of the spa via a lateral nasal wall incision was achieved. Pdf endoscopic endonasal ligation of the sphenopalatine artery. The anterior ethmoid artery is an extension of the ophthalmic artery, which is a branch of the internal carotid artery system. In many instances it is minor or selflimiting and persons do not seek medical treatment. Pdf endoscopic sphenopalatine artery ligation when. Sphenopalatine artey cauterization for refractory epistaxis. Ligation of the sphenopalatine artery in posterior. Endoscopy with sphenopalatine ligation gains a code. Landmarks for rapid localization of the sphenopalatine.
Anatomical and surgical study of the sphenopalatine artery. The sphenopalatine artery bjorl brazilian journal of. Sharp et al5 reported a series of ten consecutive patients that had undergone endoscopic ligation of 11 sphenopalatine arteries over a 26 month period. In recent years the increased availability of rigid endoscopes and a better understanding of the anatomy of the nasal cavity have facilitated a direct approach to the sphenopalatine artery. 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 sage journals. Costeffectiveness analysis of endoscopic sphenopalatine. Endoscopic sphenopalatine artery ligation for acute. Ligation of the anterior ethmoidal artery is commonly performed in patients with a history of trauma. Endoscopic clip appliers facilitate clip application. Endoscopic endonasal greater palatine artery cauterization for control of recurrent anterior epistaxis anna butrymowicz, md. Ligation was performed using two small metal clips placed on the artery.
Pdf internal maxillary artery ligation for persistent posterior epistaxis is traditionally performed via the transantral approach. Cauterization was performed using an active device for ultrasonic treatment. Sphenopalatine artery ligation under local anesthesia. 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. I dont see a cpt code for this procedure can i use 30920. Microsurgical ligation of the sphenopalatine artery was introduced by prades in the 1970s.
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