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Η σφηνοϋπερώια αρτηρία (sphenopalatine artery – SPA), ως τελικός κλάδος της γναθιαίας αρτηρίας, προερχόμενη από το αρτηριακό δίκτυο της έξω καρωτίδας, αποτελεί την σημαντικότερη πηγή αιμάτωσης της ρινικής κοιλότητας· εντοπίζεται στο οπίσθιο τμήμα της ρινικής κοιλότητας, και συμμετέχει στην μεγάλη πλειοψηφία των σοβαρών περιστατικών επίσταξης. Με την παρούσα ανασκόπηση της βιβλιογραφίας μελετήθηκαν οι ανατομικές παραλλαγές της SPA καθώς και ο ρόλος που αυτή διαδραματίζει στις νεότερες θεραπευτικές τεχνικές της ενδοσκοπικής απολίνωσης και καυτηριασμού. Το βασικό συμπέρασμα της μελέτης είναι ότι στην μεγάλη πλειοψηφία των περιπτώσεων η SPA δίνει τουλάχιστον δύο αρτηριακούς κλάδους στο επίπεδο του σφηνοϋπερώιου τρήματος – πρόκειται για τον οπίσθια-έξω ρινικό και τον οπίσθιο διαφραγματικό κλάδο, με πολλαπλές ανατομικές παραλλαγές σε σχέση τόσο με την πορεία, όσο και με την διακλάδωσή τους. Σημαντικοί επιπλέον, κλάδοι, είναι η ανωτάτη φαρυγγική καθώς και η αρτηρία του πτερυγοειδούς πόρου. Σε όλες τις περιπτώσεις η ηθμοειδής ακρολοφία του υπερώιου οστού (crista ethmoidalis) χρησιμεύει ως ένα σταθερό ανατομικό ορόσημο το οποίο μπορεί να βοηθήσει στον προσανατολισμό εντός της ρινικής κοιλότητας ανεξάρτητα από τις οποιεσδήποτε ανατομικές παραλλαγές εντοπιστούν. Ο ενδοσκοπικός καυτηριασμός και / ή απολίνωση των κλάδων της SPA αποτελούν εξαιρετικά αποτελεσματικές τεχνικές ελέγχου της ανθεκτικής στην συντηρητική αγωγή επίσταξη – χρειάζεται σαφώς περαιτέρω έρευνα προκειμένου να διαπιστωθεί αν κάποια από τις τεχνικές αυτές υπερτερεί έναντι της άλλης., The sphenopalatine artery (SPA), as a terminal branch of the maxillary artery, originating from the external carotid artery, is the most important source of blood supply to the nasal cavity; it is located in the posterior part of the nasal cavity and participates in the great majority of serious nosebleed incidents. The present literature review studies the anatomical variations of SPA as well as the role it plays in the newer therapeutic techniques of endoscopic ligation and cauterization. The main conclusion of the study is that in the vast majority of cases the SPA gives at least two arterial branches at the level of the sphenoid foramen – these are the posterior – lateral nasal branch (PLNB) and the posterior septal branch (PSB), with multiple anatomic variations to both their route and branching. Additional branches are the superior pharyngeal and the vidian artery. In all cases the crista ethmoidalis, as a stable anatomical landmark, can aid in orientation within the nasal cavity regardless of any anatomical variations identified. Endoscopic cauterization and/or ligation of the SPA branches are highly effective control techniques for conservatively resistant epistaxis – further research is clearly needed to determine whether one of these techniques outmach the other.

Purpose The purpose of this work was to determine the epidemiology and the predictive factors of success of the surgical management of fourth branchial anomalies. Methods This is a multicentric retrospective review from 1998 to 2016 of patients who presented with an endoscopically-confirmed fourth branchial pouch anomaly. Data were analyzed according to sex, age, clinical features, number of recurrences, treatment modalities (endoscopic and/or cervicotomy), post-operative complications and follow-up. Results Fifty-two children have been included. The average age at diagnosis was 4.5 years. Among them, 73.1% were female, 11.4% were neonatal forms; 94.2% of lesions were left-sided; 75% of patients presented a cervical abscess as first symptom, and 7.7% of children presented with dyspnea. Average time between first symptoms and management was 9.5 months. Management was endoscopic in 73.1% of patients (laser in 84.2%, coagulation in 15.8%) with about a third of recurrence after one procedure. Overall success of endoscopic procedures reached 84.2%. A cervical open surgery was performed in 26.9% as first line treatment. Overall success of cervicotomy reached 85.7%. No complications of endoscopic surgery have been identified. There were 35.7% complications of cervicotomy (2 recurrent nerve palsy, 2 keloid scars, 1 pharyngostoma). An association was proved between recurrences and initial abscess (OR = 2.44), and with age between 3 and 5 (OR = 4). Conclusion Endoscopic treatments appear to be effective in first line approach in the management of fourth branchial anomalies, offering an excellent efficiency with rare complications. We identified two risk factors of recurrence: age between 3 and 5 years old and history of cervical abscesses. Level of evidence IV.

Background Severe epistaxis is one of the most common emergencies in rhinology practices. The commonly used endoscopic cauterization of the sphenopalatine artery (SPA), alone or with the anterior ethmoidal artery (AEA), has a high success rate for controlling severe epistaxis. The current study was conducted to evaluate the endoscopic intra-operative variations of SPA between epistaxis and non-epistaxis cases. Forty consecutive patients who underwent exploration of SPA were included in the study. They were distributed into two groups depending upon the indication of SPA exploration; the epistaxis group (group A, n=25 patients, n=26 sides) and the non-epistaxis group (group B, n=15 patients, n=25 sides). Criteria of the main SPA in the two groups were compared regarding four parameters; arterial diameter, arterial adherence to the mucosa of the lower part of the basal lamella, sphenopalatine nerve bundle, and crista ethmoidalis erosion. Results A significant difference was found regarding the diameter of SPA between the two groups; a mean diameter of 4.2±0.64 mm was compared to 3.2±0.35 mm for group A and B, respectively (p=0.043). Moreover, a highly significant tendency was observed regarding the arterial adherence to the mucosa of the lower part of the basal lamella and sphenopalatine nerve bundle in the epistaxis group; (p≤0.01). Conclusion These data clearly signify the importance of intraoperative identification of SPA criteria during surgical management of severe epistaxis. These criteria may help in altering the surgical decision between solely SPA and concomitant SPA/AEA cauterization.

BACKGROUND Epistaxis is the most common emergency in otorhinolaryngology. The usual treatment in most cases of anterior epistaxis and almost all cases of posterior epistaxis is nasal packing followed by either cauterization, embolization or ligation. This study has been undertaken to evaluate the use of nasal endoscopic cauterization as the first line treatment both in anterior as well as posterior epistaxis. MATERIALS AND METHODS The study consisted of total 36 patients, who presented with epistaxis. All patients were first managed with nasal endoscopy and endoscopic electrocautery. Only the patients in which bleeding point could not be located by initial endoscopy were managed by insertion of nasal packing. The discomforts and minor complications in patients undergoing successful endoscopic cauterization and in the patients who were taken for nasal packing were observed along with average stay of patient in the hospital. RESULTS Out of total 36 patients, 28 patients (78%) could be successfully managed directly by endoscopic cauterization without undergoing nasal packing and the obvious discomfort associated with it. The average length of hospital stay in the patients without nasal pack was 1.39 days while for patients who were managed by nasal packing the average length of hospital stay was around 3 days. The patients who underwent nasal packing, 5 (62%) had minor complications. While in patients with endoscopic treatment as first line management, no such complications were observed. CONCLUSION Along with a good success rate, endoscopic cauterization is very effective in reducing the nasal packing related complications and the duration of stay of patient in the hospital, thus reducing the cost of treatment as well. This makes endoscopic cauterization a better first line management for both anterior as well as posterior epistaxis.

Objectives: The authors present the case of a 3-year-old girl with a history of complicated surgery for removing a third branchial cleft fistula. Methods: An endoscopic approach using N-butyl-2-acrylate and metacrilosisolfolane glue (GLUBRAN 2) to seal the fistula was performed. Results: The clinical and radiological 6-year follow-up confirmed the absence of the fistulous orifice and the persistence of scar due to previous open-neck surgical procedures. Conclusion: endoscopic Glubran 2 sealing has been an effective treatment procedure for branchial fistula.

Objectives To systematically review the current literature on treatment of third and fourth branchial pouch sinuses with endoscopic cauterization, including chemocauterization and electrocauterization, in comparison to surgical treatment. Data Sources PubMed, Embase, and the Cochrane Library. Review Methods We conducted a systematic search. Studies reporting original study data were included. After assessing the directness of evidence and risk of bias, studies with a low directness of evidence or a high risk of bias were excluded from analysis. Cumulative success rates after initial and recurrent treatments were calculated for both methods. A meta-analysis was conducted comparing the success rate of electrocauterization and surgery. Results A total of 2,263 articles were retrieved, of which seven retrospective and one prospective article were eligible for analysis. The cumulative success rate after primary treatment with cauterization ranged from 66.7% to 100%, and ranged from 77.8% to 100% after a second cauterization. The cumulative success rate after the first surgical treatment ranged from 50% to 100% and was 100% after the second surgical attempt. Meta-analysis on electrocauterization showed a nonsignificant risk ratio of 1.35 (95% confidence interval: 0.78-2.33). Conclusions The effectiveness of cauterization in preventing recurrence seems to be comparable to surgical treatment. However, we suggest endoscopic cauterization as the treatment of choice for third and fourth branchial pouch sinuses because of the lower morbidity rate.

Objectives To systematically review the current literature on treatment of third and fourth branchial pouch sinuses with endoscopic cauterization, including chemocauterization and electrocauterization, in comparison to surgical treatment. Data Sources PubMed, Embase, and the Cochrane Library. Review Methods We conducted a systematic search. Studies reporting original study data were included. After assessing the directness of evidence and risk of bias, studies with a low directness of evidence or a high risk of bias were excluded from analysis. Cumulative success rates after initial and recurrent treatments were calculated for both methods. A meta-analysis was conducted comparing the success rate of electrocauterization and surgery. Results A total of 2,263 articles were retrieved, of which seven retrospective and one prospective article were eligible for analysis. The cumulative success rate after primary treatment with cauterization ranged from 66.7% to 100%, and ranged from 77.8% to 100% after a second cauterization. The cumulative success rate after the first surgical treatment ranged from 50% to 100% and was 100% after the second surgical attempt. Meta-analysis on electrocauterization showed a nonsignificant risk ratio of 1.35 (95% confidence interval: 0.78-2.33). Conclusions The effectiveness of cauterization in preventing recurrence seems to be comparable to surgical treatment. However, we suggest endoscopic cauterization as the treatment of choice for third and fourth branchial pouch sinuses because of the lower morbidity rate.