Hostname: page-component-cd9895bd7-dzt6s Total loading time: 0 Render date: 2025-01-01T06:29:00.180Z Has data issue: false hasContentIssue false
  • English
  • Français

How we do it: using the nasion as a landmark for identifying the anterior ethmoidal artery

Published online by Cambridge University Press:  12 December 2022

T A Patel Open the ORCID record for T A Patel [Opens in a new window]  and
D Lubbe
T A Patel*
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, University of Pittsburgh Medical Centre, Pittsburgh, PA, USA
D Lubbe
Affiliation:
Division of Otolaryngology, Faculty of Health Services, University of Cape Town, Cape Town, South Africa, and Groote Schuur Hospital, Cape Town, South Africa
*
Corresponding author: Terral Patel; Email: patelt5@upmc.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

In severe refractory epistaxis, the anterior ethmoidal artery may need to be ligated. Previously described endonasal or transorbital approaches are not always effective, or they have suboptimal aesthetic outcomes. This paper describes a safe and effective surgical technique, with a consistent landmark allowing quick identification.

Technical description

A transcaruncular incision is made, oriented medially in the direction of the medial orbital wall towards the level of the nasion. Once onto bone, a subperiosteal plane is developed and an endoscope is used to dissect posteriorly at the level of the nasion, until the anterior ethmoidal artery is identified, and subsequently ligated.

Conclusion

The nasion is an easy, constant landmark to use for ligation of the anterior ethmoidal artery in refractory epistaxis. The traditional method of identifying the anterior ethmoidal artery is not applicable or constant enough for use during the transorbital approach. The described technique avoids injury to surrounding structures and has a satisfactory aesthetic outcome.

Keywords

Epistaxisendoscopy
Type
Short Communications
Information
The Journal of Laryngology & Otology , Volume 137 , Issue 9 , September 2023 , pp. 1054 - 1057
Copyright
Copyright © The Author(s), 2022. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Dr T Patel takes responsibility for the integrity of the content of the paper

References

Pallin, DJ, Chng, Y-M, McKay, MP, Emond, JA, Pelletier, AJ, Camargo, CA Jr. Epidemiology of epistaxis in US emergency departments, 1992 to 2001. Ann Emerg Med 2005;46:77–81CrossRefGoogle ScholarPubMed
Tunkel, DE, Anne, S, Payne, SC, Ishman, SL, Rosenfeld, RM, Abramson, PJ et al. Clinical practice guideline: nosebleed (epistaxis). Otolaryngol Head Neck Surg 2020;162:S1–38Google ScholarPubMed
Thakar, A, Sharan, C. Endoscopic sphenopalatine artery ligation for refractory posterior epistaxis. Indian J Otolaryngol Head Neck Surg 2005;57:215–18CrossRefGoogle ScholarPubMed
Pletcher, SD, Metson, R. Endoscopic ligation of the anterior ethmoid artery. Laryngoscope 2007;117:378–81CrossRefGoogle ScholarPubMed
Jones, N, Woolford, T. Endoscopic ligation of anterior ethmoidal artery in treatment of epistaxis. J Laryngol Otol 2000;114:858–60CrossRefGoogle Scholar
Floreani, SR, Nair, SB, Switajewski, MC, Wormald, PJ. Endoscopic anterior ethmoidal artery ligation: a cadaver study. Laryngoscope 2006;116:1263–7CrossRefGoogle ScholarPubMed
Moe, KS. The precaruncular approach to the medial orbit. Arch Facial Plast Surg 2003;5:483–7CrossRefGoogle Scholar
Cornelis, M, Lubbe, D. Pre-caruncular approach to the medial orbit and landmarks for anterior ethmoidal artery ligation: a cadaveric study. Clin Otolaryngol 2016;41:777–81CrossRefGoogle Scholar
Fagan, J. Open Access Atlas of Otolaryngology, Head & Neck Operative Surgery. Cape Town: University of Cape Town, 2014Google Scholar
Morera, E, Artigas, C, Trobat, F, Ferrén, L, Tomás, M. Transcaruncular electrocoagulation of anterior ethmoidal artery for the treatment of severe epistaxis. Laryngoscope 2011;121:446–50CrossRefGoogle ScholarPubMed
Moe, KS, Bergeron, CM, Ellenbogen, RG. Transorbital neuroendoscopic surgery. Neurosurgery 2010;67(3 Suppl Operative):ons16–28Google ScholarPubMed
Lubbe, D, Mustak, H, Seayaroh, K, Goncalves, N, Fagan, J. Transorbital endoscopic surgery. Curr Otorhinolaryngol Rep 2019;7:173–80CrossRefGoogle Scholar
Miller, C, Bly, R, Moe, KS. Endoscopic orbital and periorbital approaches in minimally disruptive skull base surgery. J Neurol Surg Part B Skull Base 2020;81:459–71Google ScholarPubMed
Lander, MI, Terry, O. The posterior ethmoid artery in severe epistaxis. Otolaryngol Head Neck Surg 1992;106:101–3CrossRefGoogle ScholarPubMed