V

Figure 39 Endoscopic view showing the vidian foramen (arrows) directly posterior and perpendicular to the sphenopalatine foramen (SP). S = sphenoid sinus.

Figure 40 Sagittal view of the pterygomaxillary fossa. The thin bony posterior maxillary sinus wall (small black arrows), buccal fat, and neurovascular plexus have been removed to expose the vidian foramen (V), foramen rotundum (R), pterygopalatine canal, and greater palatine neurovascular pedicle passing to the greater palatine foramen (P). The last is usually found adjacent to the second molar in the hard palate. The course of the vidian, infraorbital, and greater palatine nerves through the pterygopalatine fossa has been marked with black wire. The small white arrows denote the infraorbital nerve. S = sphenoid. PE = posterior ethmoid sinus.

Figure 40 Sagittal view of the pterygomaxillary fossa. The thin bony posterior maxillary sinus wall (small black arrows), buccal fat, and neurovascular plexus have been removed to expose the vidian foramen (V), foramen rotundum (R), pterygopalatine canal, and greater palatine neurovascular pedicle passing to the greater palatine foramen (P). The last is usually found adjacent to the second molar in the hard palate. The course of the vidian, infraorbital, and greater palatine nerves through the pterygopalatine fossa has been marked with black wire. The small white arrows denote the infraorbital nerve. S = sphenoid. PE = posterior ethmoid sinus.

Figure 41 Endoscopic view showing the internal maxillary artery (IM) running superiorly behind the posterior wall of the maxillary sinus in the pterygomaxillary fossa. S = sphenoid sinus.

B. Anterior and Posterior Ethmoid Arteries (Figure 42)

Endoscopic ligation or cauterization of the anterior ethmoid artery has been advocated in select cases with anterior epistaxis (59,60). The anterior and posterior ethmoid arteries are terminal branches of the internal carotid artery. They can be seen penetrating the periorbita into their respective bony canals coursing through the roof of the ethmoid sinus (50). The anterior and posterior ethmoid arteries re-enter the cranial cavity medially, directly anterior and posterior to the cribriform plate, respectively. Both arteries give off a meningeal branch to the dura as they re-enter intracranially.

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