With the advent of the endoscope, many traditionally open procedures are now being performed endoscopically rather than via the open approach. Transnasal endoscopic sphenopalatine artery ligation compared. The step of enlarging the window into the pps is not necessary for maxillary artery ligation, although it is often helpful to follow the sphenopalatine artery back to the maxillary artery. Sphenopalatine artery ligation under local anesthesia. Sphenopalatine article about sphenopalatine by the free. Sep 11, 2019 the patients hemoglobin and hematocrit at presentation were 8. Endoscopic control of the sphenopalatine artery for. A series of images showing steps in ligating the right sphenopalatine artery endoscopically, transnasal. Endoscopic sphenopalatine artery ligation when, why and. The patients hemoglobin and hematocrit at presentation were 8. The film presents the finding of the sphenopalatine artery which enters in the nose through the sphenopalatine foramen where it divides into two branches.
Endoscopic ligation of the sphenopalatine artery join our community if you would like to submit events to the jlo community please register by clicking the button below. Surgery theater, with more than 12,000 educational surgery videos, is the worlds first online social medical video sharing for all health care professionals. It is a major contributor to the rich arterial plexus known as kiesselbachs plexus on the anteroinferior nasal septum. Examples of this include endoscopic sphenopalatine artery ligation. Sphenopalatine artery ligation and vidian neurectomy. Epistaxis may be classified clinically into anterior and posterior bleeds. Here it gives off its posterior lateral nasal branches. Sphenopalatine and anterior ethmoidal artery ligation for severe epistaxis. Sphenopalatine artery spa ligation or cauterization stands to be one of the most common management options. All patients had epistaxis refractory to anterior and posterior nasal packing, which was rapidly controlled following the procedure. Most professional coders use to recommend 30999 or 31299, but using these codes are also found to be controversial due to. Request pdf sphenopalatine and anterior ethmoidal artery ligation for severe epistaxis we describe the surgical treatment of severe epistaxis and evaluate.
He had facial trauma and fracture of the posterior of the maxillary sinus and the palatine bone. Endoscopic monopolar cauterization of the sphenopalatine artery. Conclusions endoscopic ligation of the sphenopalatine artery may be performed transnasally with minimal morbidity. Sphenopalatine and anterior ethmoidal artery ligation for severe.
Epistaxis is a common condition that can be managed conservatively in most cases. Endoscopic ligation of the sphenopalatine artery as a primary management of severe posterior epistaxis in patients with coagulopathy. So if you are looking to learn the latest surgical procedures or share your latest surgical knowledge, feel free to browse, learn. Sphenopalatine artery ligation and vidian neurectomy ento key. Sphenopalatine foramen an overview sciencedirect topics. Endoscopic clip appliers facilitate clip application. Endoscopic ligation of the sphenopalatine artery for refractory posterior epistaxis. Enlarge the sphenoidotomy laterally and bring it into communication with the soft tissue of the sphenopalatine foramen and medial pterygopalatine space. The analysis of the endoscopic anatomy of the sphenopalatine artery was carried out using a nasal endoscope with a 30degree rigid scope, 4. There are no contraindications for spa cauterization. Aug 31, 2010 endoscopic ligation of sphenopalatine artery anatomy. Endoscopic ligation of sphenopalatine artery picture. Sphenopalatine artery cauterization for nasal bleeding.
It is colloquially know as the artery of epistaxis given its common involvement in cases of nose bleeds. Participants comprised patients undergoing sphenopalatine artery ligation for posterior epistaxis at three east scotland hospitals. Soap web service annotations api oai service bulk downloads. Given the unilateral presentation, antiplatelet therapy, and recently failed endoscopic control, the patient was taken to the operating room for transnasal endoscopic sphenopalatine artery ligation tespal with bipolar cautery. Endoscopic sphenopalatine artery ligation hns preferences.
No, youll need to use an unlisted code such as 30999. Current trends dictate that posterior packing should be replaced by the endoscopic ligation of the sphenopalatine artery in cases of. Endoscopic control of the sphenopalatine artery for epistaxis. Anterior ethmoidal artery ligation iowa head and neck. Endoscopic ligation of the sphenopalatine artery espal has recently become the treatment of choice for refractory epistaxis.
Endoscopic ligation of the sphenopalatine artery on vimeo. Landmarks for rapid localization of the sphenopalatine. Surgical anatomy of the sphenopalatine artery in lateral. Epistaxis is the commonest emergency in otorhinolaryngology. Aug 03, 2016 10 sphenopalatine artery ligation and vidian neurectomy. Hypertension, antiaggregant or anticoagulant use, bilateral sphenopalatine artery ligation, and previous nasal surgery do not. 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. 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. Over the last decade endoscopic sphenopalatine artery spa ligation has become a popular treatment option for posterior epistaxis and. Endoscopic ligation of the sphenopalatine artery as a. This video was given to the jlo website by dr mark samaha, assistant professor in the department of otolaryngology at mcgill university, montreal, canada endoscopic ligation of the sphenopalatine artery on vimeo. As such, this is branch is unable to be addressed by embolization techniques.
In this study, we aimed to present the results of 30 patients who underwent transnasal endoscopic sphenopalatine artery ligation tespal for. Anterior ethmoidal artery ligation is considered for continued epistaxis uncontrolled by other means. Endoscopic sphenopalatine artery ligation in posterior epistaxis. Synonyms for sphenopalatine artery in free thesaurus. Pdf endoscopic endonasal ligation of the sphenopalatine artery. Endoscopic ligation of the sphenopalatine artery for epistaxis. Transnasal endoscopic sphenopalatine artery ligation is becoming the procedure of choice for surgical management of intractable posterior epistaxis. Patient with recurrent epistaxis after the nasal packing was removed. Endoscopic sphenopalatine artery ligation is widely accepted as effective and. Please use this page as a starting point for further drilling down and researching.
Endoscopic sphenopalatine artery ligation csurgeries. 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. Crossing the under surface of the sphenoid the sphenopalatine artery ends on the nasal septum as the posterior septal branches. Landmarks for localization of the sphenopalatine foramen can assist in rapid surgical exposure of the sphenopalatine artery. The surgical steps of endoscopic sphenopalatine artery ligation. Endoscopic identification of the sphenopalatine artery in. An instructional video on the surgical technique of a sphenopalatine artery ligation. Spa ligation is generally indicated for intractable posterior epistaxis that does not settle following 24hrs of adequate anterior and posterior nasal packing, and for recurrent unilateral epistaxis unrelated to an underlying systemic disease or a drug related blood dyscrasia.
Control of sphenopalatine artery bleeding surgery video ent. Sphenopalatine artery an overview sciencedirect topics. Nov 18, 2005 endoscopic ligation of the sphenopalatine artery espal has recently become the treatment of choice for refractory epistaxis. Background transnasal endoscopic sphenopalatine artery ligation tespal and selective embolization both provide excellent treatment success rate in the management of intractable epistaxis. The aim of this study was to prospectively evaluate postoperative cessation of bleeding and late recurrence of epistaxis in a cohort of patients treated by endoscopic ligation of the sphenopalatine artery. This web page is an entry point to find 03ln4cz icd10 code mapping to icd9. Endoscopic ligation of the sphenopalatine artery for. This video depicts the endoscopic ligation of the sphenopalatine artery for control of bleeding during sinus surgery or epistaxis nosebleeds. The study provides detailed information concerning the sphenopalatine artery, which we hope will help explain the arterial bleeding that may occur during ethmoidectomy, middle meatal antrostomy, conchotomy, and endoscopic ligation of the sphenopalatine artery. Nov 23, 20 endoscopic sphenopalatine artery ligation espal. Transnasal endoscopic sphenopalatine artery ligation. The alternative procedure of endoscopic ligation of the sphenopalatine artery at its exit from the sphenopalatine foramen avoids the morbidity associated with the transantral approach. Up next sphenopalatine artey cauterization for refractory epistaxis duration.
Endovascular treatment of epistaxis american journal of. Article information, pdf download for sphenopalatine and anterior ethmoidal artery ligation for severe epistaxis open epub for. Endoscopic sphenopalatine artery ligation for refractory. Endoscopic ligation of spa sphenopalatine artery youtube. The technique of sphenopalatine artery ligation is described. Epistaxis, or nasal bleeding, is a common occurrence and has been reported in up to 60 percent of the population. Elective sphenopalatine artery ligation for recurrent epistaxis. Control of sphenopalatine artery bleeding surgery video. Endoscopic sphenopalatine artery ligation when, why and how. Endoscopic cauterization of the sphenopalatine artery to. Anterior ethmoidal artery ligation iowa head and neck protocols. Sphenopalatine artery is main artery passing blood into endoscopic ligation of sphenopalatine artery picture. Many epistaxis protocols now include endoscopic sphenopalatine artery ligation for bleeding that is refractory to packing.
Endoscopic sphenopalatine artery ligation surgery video ent. Autoplay when autoplay is enabled, a suggested video will automatically play next. Sphenopalatine artery synonyms, sphenopalatine artery. The main focus of this article is an online video tutorial on the anatomy and surgical technique of espal. Posterior septal branches of sphenopalatine artery wikipedia. Ligation of the anterior ethmoidal artery is commonly performed in patients with a history of trauma. Please feel free to provide you feedback and suggestions. However, in our study, no patient reported any of these complications. Sphenopalatine artery ligation has been shown to be associated with a shorter hospital stay and cost effectiveness compared with other surgical modalities. Anatomy of the sphenopalatine artery inferior turbinate. 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. The nasoseptal artery supplies the nasal septum and the posterior lateral nasal artery gives rise to the middle and inferior conchal arteries. Crista ethmoidalis serves as landmark just anterior to sphenopalatine foramen. I dont see a cpt code for this procedure can i use 30920.
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. Endoscopic sphenopalatine artery ligationwhen, why and how to do it. Endoscopic sphenopalatine artery ligationwhen, why and how to. Endoscopic ligation of the sphenopalatine artery elspa is emerging as a minimally invasive alternative. We have also found endo scopic sphenopalatine artery ligation to be a useful adjunct to endoscopic approaches for the resection of nasal or skull base tumors. Jun 08, 2012 also palatal numbness was reported in % of cases. Traditionally, posterior epistaxis has been managed with a sequence of nasal packing, smr, septoplasty, anterior ethmoid ligation, sphenopalatine artery ligation, transantral maxillary artery ligation, selective maxillary artery embolization and external carotid artery ligation. Endoscopic sphenopalatine artery ligation for acute idiopathic. Endoscopic ligation of the sphenopalatine artery as a primary. However, there are complications in more than 25% of patients undergoing these techniques. Click to complete our 2minute survey and help us improve the quality of our website and videos. I did an endoscopic ligation of the left sphenopalatine artery for recurrent epistaxis in a patient with coumadininduced coagulopathy. 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. Oct 17, 2011 this video depicts the endoscopic ligation of the sphenopalatine artery for control of bleeding during sinus surgery or epistaxis nosebleeds.
Endoscopic ligation of sphenopalatine artery anatomy. It was performed endoscopic endonasal approach to the pterygopalatine fossa and ligation of the artery inside the pterygopalatine fossa for a proximal control. Sphenopalatine artery definition of sphenopalatine artery. September 30th, 2016 by sue belley, rhia challenge question. Endoscopic ligation of spa sphenopalatine artery on vimeo. Our experience with endoscopic sphenopalatine artery ligation for four patients with posterior existaxis is described. Endoscopic sphenopalatine artery ligation is an effective method of treatment for posterior epistaxis. This short video demonstrates their technique for dividing the sphenopalatine artery spa in the management of refractory. Ligation was still lateral to the sphenopalatine foramen, but the author noted the difficulty encountered isolating the artery on the medial side of the foramen. Endoscopic sphenopalatine artery ligation surgery video. Sphenopalatine artery definition of sphenopalatine.
Knowledge on the anatomy of the sphenopalatine artery spa and its. What is the evidence for sphenopalatine artery ligation. Subjects who underwent consecutive monopolar sphenopalatine artery ligation for intractable epistaxis performed by a senior author from. 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. Other invasive options for refractory epistaxis are anterior ethmoid artery ligation and embolization of the internal maxillary artery by neurointerventional radiology. Endoscopic endonasal ligation of the sphenopalatine artery. We report our experience of elspa in patients with a mean followup of months.
Endoscopic cauterization of the sphenopalatine artery to control severe and recurrent posterior epistaxis. This is endoscopic ligation of spa sphenopalatine artery by sinusvideos on vimeo, the home for high quality videos and the people who love them. Endoscopic skull base surgery, transnasal, endonasal endoscopically, control nasal bleeding, hemorrhage, sphenopalatine artery control of bleeding, endoscopic control. 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. Health, general arteries medical examination nosebleed case studies. Few longterm studies comparing these approaches have been previously published. The anterior ethmoid artery is an extension of the ophthalmic artery, which is a branch of the internal carotid artery system. Endoscopic ligation of the sphenopalatine artery the. Despite its benignity, it may displace or compress several vital contiguous neurological and vascular structures. Endoscopic sphenopalatine artery ligation karenzupko.