Department of Otolaryngology-Head and Neck Surgery, Henry Ford Hospital, Detroit, MI.
Wayne State University School of Medicine, Wayne State Medical University, Detroit, MI.
Int Forum Allergy Rhinol. 2019 Aug;9(8):842-849. doi: 10.1002/alr.22345. Epub 2019 Apr 23.
Postoperative arterial epistaxis and sphenoid sinus stenosis after sphenoidotomies for endoscopic sinus surgery (ESS) and transsphenoidal approaches (TSAs) are uncommon. One potential source of epistaxis after sphenoidotomy is the sphenopalatine artery's posterior septal branch (PSB). PSB injury, in addition to other factors, could increase the risk of sphenoid stenosis. The purpose of this study was to determine incidence of, and risks factors for, the following outcomes after sphenoidotomy: PSB injury; postoperative epistaxis from the injured PSB; and sphenoid stenosis after PSB injury.
A single-institution, prospective case series was conducted based on 233 sphenoidotomies performed during ESS (n = 163) and TSAs (n = 70). Outcome measures included intraoperative PSB injury, postoperative epistaxis from the PSB, and sphenoid stenosis.
The incidence of PSB injury was 17.2% during ESS-related sphenoidotomies, and 5.7% during TSA-related sphenoidotomies (p = 0.010). After PSB injury during ESS- and TSA-related sphenoidotomies (n = 32), there was 1 instance of epistaxis from the PSB (3.1%). Of the 161 ESS-related sphenoidotomies, 6 developed complete or near-complete stenosis (3.7%), which was more likely to occur with smaller anterior sphenoid face dimensions (p = 0.001). PSB injury, revision sphenoidotomy, and other factors did not increase the risk of stenosis. None of the TSA-related sphenoidotomies stenosed completely. Median follow-up was 7 months.
PSB injury occurred in 17.2% of ESS-related sphenoidotomies and 5.8% of TSA-related sphenoidotomies. After PSB injury, postoperative epistaxis from the PSB was rare (3.1%). After ESS-related sphenoidotomies, sphenoid stenosis was rare (3.7%), and was more likely to occur with smaller sphenoid dimensions, but not with PSB injury or other factors.
内镜鼻窦手术（ESS）和经蝶窦入路（TSA）后发生的蝶窦切开术后动脉性鼻出血和蝶窦狭窄并不常见。蝶窦切开术后发生鼻出血的一个潜在原因是蝶腭动脉的后鼻中隔支（PSB）。PSB 损伤以及其他因素可能会增加蝶窦狭窄的风险。本研究的目的是确定蝶窦切开术后以下结果的发生率和危险因素：PSB 损伤；PSB 损伤后来自受伤 PSB 的术后鼻出血；以及 PSB 损伤后的蝶窦狭窄。
一项单机构前瞻性病例系列研究基于 ESS（n = 163）和 TSA（n = 70）期间进行的 233 例蝶窦切开术。结局测量包括术中 PSB 损伤、PSB 损伤后的术后鼻出血以及蝶窦狭窄。
ESS 相关蝶窦切开术中 PSB 损伤的发生率为 17.2%，而 TSA 相关蝶窦切开术中为 5.7%（p = 0.010）。ESS 和 TSA 相关蝶窦切开术中 PSB 损伤后（n = 32），有 1 例来自 PSB 的鼻出血（3.1%）。在 161 例 ESS 相关的蝶窦切开术中，有 6 例发生完全或接近完全狭窄（3.7%），在前蝶骨面尺寸较小的情况下更可能发生狭窄（p = 0.001）。PSB 损伤、修正性蝶窦切开术和其他因素并未增加狭窄的风险。没有一例 TSA 相关的蝶窦切开术完全狭窄。中位随访时间为 7 个月。
ESS 相关的蝶窦切开术中 PSB 损伤的发生率为 17.2%，而 TSA 相关的蝶窦切开术中为 5.8%。PSB 损伤后，来自 PSB 的术后鼻出血罕见（3.1%）。在 ESS 相关的蝶窦切开术后，蝶窦狭窄罕见（3.7%），并且更可能发生在前蝶骨面尺寸较小的情况下，但与 PSB 损伤或其他因素无关。
