Anatomical Correlation Between Nasal Vascularisation and the Design of the Endonasal Pedicle Flaps.

Arteries that supply the nasal septum and the lateral nasal wall include vessels that originate from the external carotid artery and from the internal carotid artery. A variety of local endonasal pedicle flaps can be used in different anatomical areas for endoscopic skull base reconstruction. The main flaps are based on terminal branches of the sphenopalatine artery and on anterior ethmoidal artery. This study will describe the anatomy of these vessels and their relationship with the main flaps.

[Pedicle flaps based on the sphenopalatine artery: anatomical and surgical study]. / Colgajos pediculados procedentes de la arteria esfenopalatina: estudio anatómico y quirúrgico.

INTRODUCTION: Local pedicle flaps based on the sphenopalatine artery make it possible to reconstruct large defects of the skull base (SB). MATERIAL AND METHODS: From January 2008 to January 2013, 64 lesions with involvement of SB were analysed. These lesions were treated using endoscopic endonasal approach and required a pedicle flap based on the sphenopalatine artery. In addition, measurements and flexibility of the flaps were examined in 4 cadaveric nasal cavities. RESULTS: Surgical group. Sixty-four nasoseptal flaps (NSF) were used, in 4 cases associated with a middle turbinate flap (MTF), and in 1 case supplemented with an inferior turbinate flap (ITF). Five cerebrospinal fluid fistulas (8%) were noted. Among patients with initial lesions, 7% presented an anosmia. Cadaveric group. The length of the NSF varied between 5.2 cm and 7.7 cm and the width ranged from 3 cm to 4.5 cm. The ITF provided an anterior-posterior distance between 4.2 cm and 5 cm, with a width between 1.2 cm and 2.8 cm. The mean length of MTFs varied between 3.5 cm and 4.2 cm, with a width between 1.4 cm and 1.9 cm. CONCLUSION: The most versatile local flap for the reconstruction of skull base defects is the NSF, and flaps pedicled to the posterolateral nasal artery offer an excellent alternative.

Anatomical and surgical study of the sphenopalatine artery branches.

The sphenopalatine artery gives off two main branches: the posterior lateral nasal branch and the posterior septal branch. From 2007 to 2012 17 patients were treated with cauterization and/or ligature of the sphenopalatine artery with endonasal endoscopic approach. 90 nasal dissections were performed in 45 adult cadaveric heads. We evaluated the number of branches emerging from the sphenopalatine foramen and the presence of an accessory foramen. In the surgery group, we observed a single trunk in 76% of the patients (13/17) and a double trunk in 24% (4/17). We found an accessory foramen in four cases. We obtained a successful result in bleeding control in 88% of the cases. In the cadaver dissection group, 55 nasal cavities had a single arterial trunk (61%), 30 had 2 arterial trunks (33%) and in only 5 nasal fossae we observed 3 arterial trunks (6%). We were able to dissect four accessory foramina. We suggest that in most cases only one or two branches are found in the sphenopalatine foramen.

Epidemiology of epistaxes admitted to a tertiary hospital.

INTRODUCTION AND OBJECTIVES: Epistaxis has been known since antiquity. However, we have limited epidemiological data at our disposal. The aim of this study is to know the main epidemiological characteristics of the cases of epistaxis admitted and to determine the factors associated with the recurrence of bleeding. METHODS: A retrospective study was conducted including admissions for epistaxis in the ENT department of our hospital during the period between January, 2003, and December, 2008. We analyzed the distribution by gender, age, location and time of year. The aetiological causes identified included systemic and local factors. We analyzed the variables related to bleeding recurrence. RESULTS: We evaluated 178 cases of epistaxis: 68% of patients were male (121/178), compared to 32% of women (57/178). The median age (p25-p75) was 65 (53-75) years. The epistaxes were most noticeable during the months of January and April. Among the systemic causes, hypertension (56%), anti-platelet treatment (23%) and anti-coagulant therapies (18.5%) predominated. Local factors were much less numerous than general ones (11% v. 68%). Recurrent bleeding was present in 14% of cases (25/178) and only the posterior location was shown to influence this variable (P<.05). CONCLUSIONS: The typical pattern of the patients admitted to our department for epistaxis is a middle-aged or elderly male with underlying co-morbidity and posterior epistaxis.