Patel T A, Lubbe D
Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh Medical Centre, Pittsburgh, PA, USA.
Division of Otolaryngology, Faculty of Health Services, University of Cape Town, Cape Town, South Africa, and Groote Schuur Hospital, Cape Town, South Africa.
J Laryngol Otol. 2023 Sep;137(9):1054-1057. doi: 10.1017/S0022215122002523. Epub 2022 Dec 12.
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.
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.
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.
在严重难治性鼻出血中，可能需要结扎筛前动脉。先前描述的鼻内或经眶入路并不总是有效，或者美学效果欠佳。本文描述了一种安全有效的手术技术，具有一致的标志点，便于快速识别。
做一个经泪阜切口，向内朝着眶内壁方向朝向鼻根水平。一旦到达骨面，形成骨膜下平面，使用内窥镜在鼻根水平向后解剖，直到识别出筛前动脉，随后进行结扎。
鼻根是难治性鼻出血中结扎筛前动脉的一个容易且恒定的标志点。传统的识别筛前动脉的方法在经眶入路中适用性不足或不够恒定。所描述的技术避免了对周围结构的损伤，并且美学效果令人满意。
