An Unusual Variant of the Sphenopalatine Foramen and Artery with an Absent Crista Ethmoidalis: An Intra-Operative Challenge

Sphenopalatine artery ligation (SPL) is a surgical remedy for severe epistaxis. This procedure  requires  extensive  knowledge  of  the  various  anatomical  variants.  Its topographical anatomy varies and reliable landmark such as the crista ethmoidalis may be absent. These variations are crucial and they dictate the outcome of the surgery.  We  present  a  peculiar  case  of  a  postero-superiorly  located  variant  of the  sphenopalatine  foramen  and  artery  with  an  absent  crista  ethmoidalis.  The sphenopalatine foramen was found superiorly at the superior meatus beyond the horizontal  part  of  the  lamella  of  the  superior  concha.  Only  one  trunk  was  seen exiting  the  sphenopalatine  foramen.  The  sphenopalatine  foramen  was  measure rom the anterior part of the nose. It was 69mm from the nasal sill and 54mm limen nasi.