S.50.210

Ligation of the sphenopalatine artery

The middle turbinate (MT) has been medialized to allow the simultaneous passage of the endoscope and dissecting instruments into the middle meatus. A naso-antral window has been opened, enlarging the natural ostium of the maxillary sinus, and has been extended posteriorly to expose the posterior wall of the antrum (PWA). The sphenopalatine artery with its anterior and posterior branches have been identified as it exits the pterygosphenopalatine fossa (PTF) and enters the nose. For purposes of the illustration, the artery has been dissected in the pterygopalatine fossa by removing part of the posterior wall of the antrum. In most instances, however, the exposure of the SPA within the PTF is not needed. After the main trunk is identified and mobilized, the adjustable clip applier (S.50.210) is used to apply a medium-size vascular clip through the middle meatus. Whenever possible, the posterior nasal artery and anterior branches are also clipped.