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. 2011 Jan-Feb;77(1):33-8.
doi: 10.1590/s1808-86942011000100006.

[Endoscopic ligation of the anterior ethmoidal artery: a cadaver dissection study]

[Article in Portuguese]
Bernardo Cunha Araujo Filho  1 , Carlos Diógenes Pinheiro-Neto, Henrique Faria Ramos, Richard Louis Voegels, Luiz Ubirajara Sennes
Affiliations

[Endoscopic ligation of the anterior ethmoidal artery: a cadaver dissection study]

[Article in Portuguese]
Bernardo Cunha Araujo Filho et al. Braz J Otorhinolaryngol. 2011 Jan-Feb.

Abstract

Anterior ethmoidal artery (AEA) ligation may be necessary in cases of severe epistaxis not controllable with traditional therapy. Endoscopic endonasal ligation of the AEA is not used frequently; there are few studies in the literature for standardization of the endoscopic technique for this vessel.

Aim: To demonstrate the feasibility of periorbital AEA ligation in a transethmoidal endoscopic approach.

Methods: A prospective study where 50 nasal cavities were dissected. After anterior ethmoidectomy and partial removal of lamina papyracea, the periorbital area was carefully dissected along a subperiosteal plane to identify the AEA. The vessel was exposed within the orbit and dissected.

Results: Data on technical difficulties, complications, the learning curve and anatomical variations were gathered.

Conclusion: An endonasal endoscopic approach to the AEA within the orbit was shown to be feasible. Identifying the artery is not difficult, and this technique avoids external incisions. This approach appears to be an excellent alternative for approaching the AEA. Further clinical studies are needed to demonstarte the benefits of this technique.

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Figures

Figure 1
Figure 1
Exposed anterior ethmoid artery - subperiosteal plane, left orbit - during endoscopic dissection of a cadaver (45° endoscope). Note the dehiscent intranasal trajectory in a posterior-anterior direction.
Figure 2
Figure 2
Angled forceps with Ligclip, used in procedures; detailed image of its tip.
Figure 3
Figure 3
Forceps with Ligclip LT 200 around the artery on the medial wall of the orbit (45° endoscope).
Figure 4
Figure 4
Ligclip on the left anterior ethmoid artery - subperiosteal plane.
Figure 5
Figure 5
Right anterior ethmoid artery within the bony canal and exposed in the orbit after removing the lamina papyracea. Note the proximity to the cranial base.
See this image and copyright information in PMC

References

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