Stepnick D W, Maniglia A J, Bold E L, Maniglia J V
Department of Otolaryngology-Head and Neck Surgery, Case Western Reserve University, School of Medicine, Cleveland, OH 44106.
Laryngoscope. 1990 Nov;100(11):1166-70. doi: 10.1288/00005537-199011000-00006.
Surgical control of severe epistaxis is usually reserved for cases refractory to more conservative techniques. We present our experience with intraoral ligation of the maxillary artery as it courses through the buccal fat pad before it enters the pterygopalatine fossa and branches posterior to the maxilla. This technique has been found useful in the control of nasal hemorrhage as well as an adjunct to other surgical procedures, such as removal of benign and malignant neoplasms involving the maxilla and paranasal sinuses. This technique was used for ligation of the maxillary artery in 20 patients. The artery was readily identified in some cases, but required more extensive dissection in others; therefore, an anatomic study in 18 preserved and fresh cadaver specimens was undertaken to investigate the variability of the maxillary artery in the region of the buccal fat pad. There appeared to be significant variation in the distance from the buccal mucosal incision site, as well as variation in the relationship to the pterygoid muscles. This relationship to the pterygoids explains the occasional difficulty in locating the artery for ligation. This technique represents a reasonable alternative to the more traditional transantral approach to ligation of the maxillary artery, as long as the surgeon understands the anatomy of the region, its variations, and where the artery may be located if not immediately apparent. No major complications have been experienced.
严重鼻出血的手术控制通常仅用于对更保守技术无效的病例。我们介绍我们对上颌动脉经口结扎的经验，该动脉在进入翼腭窝并在上颌骨后方分支之前穿过颊脂垫。已发现该技术在控制鼻出血以及作为其他外科手术（如涉及上颌骨和鼻窦的良性和恶性肿瘤切除）的辅助手段方面很有用。该技术用于20例患者的上颌动脉结扎。在某些病例中动脉很容易识别，但在其他病例中需要更广泛的解剖；因此，对18个保存的新鲜尸体标本进行了一项解剖学研究，以调查颊脂垫区域上颌动脉的变异情况。从颊黏膜切口部位的距离似乎存在显著差异，与翼肌的关系也存在差异。与翼肌的这种关系解释了偶尔在定位动脉进行结扎时遇到的困难。只要外科医生了解该区域的解剖结构、其变异情况以及动脉在不立即显现时可能的位置，该技术是对上颌动脉结扎更传统的经窦途径的合理替代方法。未出现重大并发症。
