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Arterial ligation for pediatric epistaxis: developmental anatomy
Glenn Isaacson1, Janet M Monge
1Department of Otolaryngology, Head and Neck Surgery, Temple University School of Medicine, Philadelphia, Pennsylvania 19140, USA.
Insights
Pediatric epistaxis treatment requires understanding skull growth. This study used ancient skulls to map key arterial and optic canal distances, informing safer surgical approaches for children.
Area of Science:
- Anthropology
- Pediatric Surgery
- Anatomy
Background:
- Surgical ligation of nasal feeding vessels is used for severe epistaxis in adults.
- Limited pediatric skull studies hinder surgical design for children.
- Archeological specimens offer a unique resource for pediatric craniofacial growth research.
Purpose of the Study:
- To conduct an anthropometric study of archeological pediatric skulls.
- To investigate the effects of growth on key craniofacial and orbital anatomic relationships.
- To provide data for safe surgical interventions in pediatric epistaxis.
Main Methods:
- Anthropometric measurements were taken from ancient pediatric skulls (200-8000 years old).
- Key distances measured included lacrimal crest to ethmoidal artery foramina and optic canal, and pyriform aperture to sphenopalatine artery foramen.
- Measurements were correlated with estimated postnatal age based on facial growth and dental development.
Main Results:
- Rapid orbital and midfacial growth occurs in the first 6 years of life.
- Gradual growth continues from 7 years to adulthood.
- The medial orbital wall length doubles, with significant anterior half enlargement.
Conclusions:
- Intractable pediatric epistaxis, particularly post-trauma, may necessitate arterial ligation.
- Understanding evolving orbital anatomy is crucial for safe ethmoidal artery ligation in children.
- This study provides parameters for endoscopic, transnasal sphenopalatine artery ligation in growing pediatric patients.
Background:
Anatomic studies of adult skulls have aided in the design of operations for the surgical ligation of nasal feeding vessels in the treatment of severe epistaxis. Lack of appropriate specimens has prevented similar studies in children. We performed an anthropometric study of archeological specimens to learn the effects of growth on key anatomic relationships.
Methods:
We studied the skulls of children who died between 200 and 8000 years ago, recovered from archeological digs around the world. Measurements of the distances from the posterior lacrimal crest to the foramina of anterior and posterior ethmoidal arteries and optic canal and the pyriform aperture to the foramen of the sphenopalatine artery were made and compared with postnatal age, estimated from facial growth and dental eruption patterns.
Results:
There is rapid growth in the orbit and midface during the first 6 years of life and gradual growth between 7 years and adulthood. The length of the medial wall of the orbit doubles during development with disproportionate enlargement of its anterior half.
Conclusion:
Arterial ligation is sometimes required for intractable pediatric epistaxis, especially after trauma. The changing relationships of critical structures in the orbital must be understood to allow safe ethmoidal artery ligation. The transantral approach to the maxillary artery is greatly limited by lack of midfacial development and maxillary pneumatization. We describe the necessary parameters for endoscopic, transnasal sphenopalatine artery ligation in growing children.
