Ultrasound examination of the Kisselbach–Little area
Alsu R. Kormilina, Н.С. Серова, Munir G. Tukhbatullin, Marat N. Gilyalov
Abstract
The arteries supplying the nasal septum and the lateral wall of the nose include vessels that originate from the external carotid artery and the internal carotid artery. Endonasal mucosal pedicle flaps located in the upper parts of the nasal cavity can be used for plastic surgery on the nasal septum. The main flaps are supplied with blood by the terminal branches of the cuneiform-palatine artery and the anterior ethmoid artery, these same branches are involved in the formation of Kisselbach–Little area in the lower third of the nasal cavity. The aim of the study was to study the opportunities of ultrasound examinations of Kisselbach–Little area in predicting viability of relocatable endonasal mucosal flaps to close the perforated foramen of the nasal septum. Materials and methods. In 2022–2025, 56 subjects were examined at the Autonomous Public Health Care Institution «Republican Clinical Hospital» under the Health Ministry of the Republic of Tatarstan, 20 of them had no pathology of the nasal septum (control group), 36 had perforation of the nasal septum (20 women, 16 men aged 18 to 52 years). Ultrasound examination of Kisselbach–Little area was performed using SUPERSONIC AIXPLORER (France) and RESONA 7 (Mindreuil, China) scanners with linear sensors with a frequency of 10-16 MHz. Duplex color scanning revealed a network of blood vessels above, near and below the perforated foramen of the nasal septum. The maximum and minimum blood flow rates and the resistance index in the arterial vessels of Kisselbach–Little area were determined. Results. In control group subjects, maximum blood flow velocity in the arterial vessels of Kisselbach–Little area reached 15-35 cm/s, the resistance index was 0.5–0.59 units. A decrease in the maximum blood flow velocity (less than 15 cm/s) and an increase in the resistance index (more than 0.59 units) are significantly associated with an increased risk of necrosis of the displaced endonasal flap to close the perforated foramen of the nasal septum. Conclusions. Ultrasound examination in color duplex scanning mode makes it possible to determine the hemodynamic parameters of arterial vessels in Kisselbach–Little area. Hemodynamic parameters of arterial vessels in Kisselbach–Little area make it possible to assess the blood supply to potentially displaced endonasal mucosal flaps to close the perforated foramen of the nasal septum and predict their engraftment.