A 70-year-old hypertensive patient presents with severe posterior epistaxis uncontrolled by anterior nasal packing. After failed posterior packing, endoscopic sphenopalatine artery ligation (ESAL) is performed. Which foramen does the sphenopalatine artery traverse to enter the nasal cavity?

• A Sphenopalatine foramen (between the sphenoid and the vertical plate of palatine bone, opening into the posterior nasal cavity just posterior to the middle turbinate) ✓
• B Incisive foramen (between the premaxilla and the horizontal plate of palatine bone, for nasopalatine nerve)
• C Pterygoid canal (Vidian canal), through the base of the pterygoid plates
• D Greater palatine foramen, opening on the hard palate posterolaterally

Explanation

The sphenopalatine artery (terminal branch of the internal maxillary artery) enters the nasal cavity through the sphenopalatine foramen, located at the posterior end of the middle turbinate attachment to the lateral nasal wall — typically just posterior to the junction of the middle meatus and the sphenoethmoidal recess. Endoscopic sphenopalatine artery ligation (ESAL) is performed here and has a 90-95% success rate for posterior epistaxis, superior to posterior nasal packing. The incisive canal transmits the nasopalatine nerve/artery to the anterior nasal septum (Kiesselbach's area).

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.