The Arterial Pattern of the Upper Nasal Septum (S‐Point) and Potential Role in Severe Epistaxis

• Published in: The Laryngoscope 2023-09, Vol.133 (9), p.2075-2080
• Main Authors: Rezende, Natália Cerqueira, Leonel, Luciano C.P.C., Kosugi, Eduardo Macoto, Pinheiro‐Neto, Carlos Diógenes, Peris‐Celda, Maria
• Format: Article
• Language: English
• Subjects: anterior ethmoidal artery; Epistaxis; Laryngoscopy; posterior ethmoidal artery; sphenopalatine artery; S‐point
• ISSN: 0023-852X; 1531-4995
• DOI: 10.1002/lary.30487

Objectives The previously described S‐point, corresponds to the medial projection of the middle turbinate axilla in the superior nasal septum and has been identified as a common source of severe epistaxis. The objective is to define the anatomical patterns of vascularization of the S‐point area that could explain its clinical relevance. Methods Thirty‐three nasal septums of latex‐injected formalin‐embalmed and fresh human cadaveric heads were dissected to analyze the arterial arrangement of the S‐point area. Measurements and patterns of vascularization were described. Results The S‐point area, was consistently surrounded by a single or multiple arterial anastomotic arches consistently formed superiorly by the anterior ethmoidal and posterior ethmoidal artery branches, and inferiorly by the posterior septal artery. The caliber of the arterial arches was typically larger than the caliber of the arterial branches supplying them. A single arch was present in 36.3% of septums, and multiple arches in 63.6%. The mean distance from the S‐point to the anterior limit of the arch was 9 mm, to the posterior arch when the present was 3 mm, to the superior limit 6 mm, to the inferior limit 6 mm, and to the nasal roof was 10 mm. Conclusion This study demonstrates the dense arterial configuration of the S point area, which is characterized by a single or multiple vascular arches of greater caliber than the branches of origin. This finding could explain why the S‐point area is a frequent source of epistaxis, and guide its surgical cauterization when an obvious vascular ectasia is not visualized. Level of Evidence N/A Laryngoscope, 133:2075–2080, 2023 The previously described S‐point, corresponds to the medial projection of the middle turbinate axilla in the superior nasal septum and has been identified as a common source of severe epistaxis. The rich anatomical patterns of vascularization of the S‐point area could explain why this area is a common site of severe epistaxis and guide its surgical cauterization when an obvious vascular ectasia is not visualized.