El-Shaarawy E A A, Hassan S S
Department of Medical Education, California University of Science & Medicine, School of Medicine (CalMed), 217 E. Club Center Drive, Suite A, 92408 San Bernardino, California 92408, United States; Anatomy and Embryology Department, Faculty of Medicine, Cairo University, Egypt, Egypt.
Folia Morphol (Warsz). 2018;77(2):345-355. doi: 10.5603/FM.a2017.0104. Epub 2017 Nov 13.
Epistaxis is a frequent problem otorhinolaryngologists faces of in their practice. The variations of the sphenopalatine foramen (SPF) and consequ-ently the artery may be one of the major sources of such bleeding. The present work aimed to localise the site of SPF and also to illustrate its different shapes, number and any other variation.
In the current study, 20 adult skulls of both sexes with total 40 half skulls were used in addition to 20 heads of adult living subjects of both sexes aged between 30 and 60 years examined with multislice helical com-puted tomography with 3-dimensional reconstruction of SPF. Then, examination of another ten dried skulls with endoscope was performed.
The number of the SPF is varied being single in nearly 80% and multiple in 20% of examined cases. The shape of the foramen also is varied; regular in 67.5% and irregular in 32.5% of all cases. The site of the foramen on the lateral nasal wall is placed in the superior meatus in most of examined skulls (62.5%) while in the rest (37.5%) they are found in the superior meatus and extending to the middle one.
There are variation of the number, shape and site of the SPF, and consequently of the branches of the sphenopalatine artery, and this may explain the surgical failure in management of severe epistaxis. The data obtained from the current work support the predication of more than one sphenopalatine ar-teries and gives ample knowledge on the endoscopic study of the lateral nasal wall and consequently the surgical treatment of severe epistaxis. (Folia Morphol 2018; 77, 2: 345-355).
鼻出血是耳鼻喉科医生在临床实践中经常遇到的问题。蝶腭孔（SPF）的变异以及由此导致的动脉变异可能是此类出血的主要来源之一。本研究旨在确定SPF的位置，并阐明其不同的形状、数量及其他变异情况。
在本研究中，除了对20具成年男女的颅骨（共40个半颅骨）进行研究外，还对20名年龄在30至60岁之间的成年男女活体头部进行了多层螺旋计算机断层扫描，并对SPF进行三维重建。然后，使用内窥镜对另外10具干燥颅骨进行检查。
SPF的数量各不相同，在近80%的检查病例中为单个，20%为多个。孔的形状也各不相同；在所有病例中，67.5%为规则形，32.5%为不规则形。在大多数检查的颅骨（62.5%）中，孔在鼻外侧壁上的位置位于上鼻道，而在其余（37.5%）的颅骨中，孔位于上鼻道并延伸至中鼻道。
SPF的数量、形状和位置存在变异，蝶腭动脉的分支也随之变异，这可能解释了严重鼻出血治疗中手术失败的原因。本研究获得的数据支持了存在多条蝶腭动脉的推测，并为鼻外侧壁的内窥镜研究以及严重鼻出血的手术治疗提供了丰富的知识。（《形态学杂志》2018年；77卷，第2期：345 - 355页）
