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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
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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

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Footnotes

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

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