EPISTAXIS

  • Dominant supply = internal Maxillary Artery (IMAX)
  • IMAX branches
    • Sphenopalatine artery (SPA)
    • Greater Palatine artery (GPA)
  • IMAX ANATOMY:
    • Origin off ECA = Behind neck mandible
    • IMAX course through parotid gland
  • IMAX 3 Segments:
    • 1. Mandibular (middle meningeal artery is a bench)
    • 2. Pterygoid
    • 3. Pterygopalatine
  • Proximal IMAX segmental branches (MIADA)
    • Middle Meningeal (MMA)
    • Inferior alveolar
    • Accessory meningeal (AccMA)
    • Deep auricular
    • Anterior Tympanic
  • Proximal IMAX branches (MIADA) —> ECA/ICA Collateralization (esp. ICA stenosis/obstruction)
  • Post-Embo SE = Jaw claudication
LARGE ARROW: RETINA, CILIARY BLUSH; SMALL ARROW: BLUSH
  1. Ophthalmic; 2. Extraorbital ophthalmic; 3. Angular; 4. SPA; 5. Infraorbital; 6. Superior labial/lateral nasal branches; 7. Posterior superior alveolar artery; 8. Descending palatine artery; 9. Buccal; 10. Anterior deep temporal artery

References:

Epistaxis Seminars in IR