Sphenopalatine foramen: endoscopic approach with bony landmarks

Area of Science:

• Otolaryngology
• Medical Imaging
• Surgical Anatomy

Background:

• Endoscopic approaches to the sphenopalatine foramen are crucial in treating various sinonasal conditions.
• Accurate identification of the sphenopalatine foramen is essential for successful endoscopic procedures.
• Reliance on intraoperative anatomical variations can pose challenges in endoscopic sinus surgery.

Purpose of the Study:

• To evaluate the reliability of nasal bony landmarks on computed tomography (CT) for endoscopic sphenopalatine foramen identification.
• To establish CT-based landmarks that can guide surgeons during endoscopic procedures.
• To determine the clinical utility of specific bony landmarks in relation to the sphenopalatine foramen.

Main Methods:

• A prospective study analyzed 102 helical CT scans of the paranasal sinuses.
• Two senior ENT surgeons measured distances from the sphenopalatine foramen to key bony landmarks.
• Measurements included distance from the posterior fontanelle and inferior turbinate attachment.

Main Results:

• Analysis included 102 patients (45 female, 57 male) with a mean age of 62 years.
• The mean distance from the posterior fontanelle to the sphenopalatine foramen was 14.1 mm (SD=2.13).
• The average vertical distance from the inferior turbinate's bony attachment to the sphenopalatine foramen was 14.13 mm, with no statistically significant differences observed for measurements.

Conclusions:

• Reliable bony landmarks identified via CT are clinically valuable for endoscopic surgery.
• The inferior turbinate concha and posterior fontanelle are proposed as dependable CT landmarks for endoscopic sphenopalatine foramen approaches.
• These landmarks can enhance the precision and safety of endoscopic procedures targeting the sphenopalatine foramen.