In a case of posterior epistaxis not controlled by anterior nasal packing, endoscopic sphenopalatine artery ligation (ESPAL) is now the preferred next step. The sphenopalatine foramen is located in which nasal meatus?

• A Inferior meatus, at the junction of the middle and posterior third
• B Superior meatus, posterior to the superior turbinate
• C Common meatus
• D Middle meatus, at the posterior end of the middle turbinate attachment to the lateral nasal wall ✓

Explanation

The sphenopalatine foramen (transmitting sphenopalatine artery and posterior nasal nerves) is located in the lateral nasal wall at the posterior end of the middle meatus, just behind the posterior attachment of the middle turbinate. Endoscopic sphenopalatine artery ligation at this point controls posterior epistaxis with ~90% success rate and has replaced posterior nasal packs and external carotid ligation as the preferred surgical approach after failed conservative measures.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.