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 measured from the anterior part of the nose. It was 69mm from the nasal sill and 54mm limen nasi.

The upper airway is a crucial structure. It becomes a grave problem should it be narrowed. Several methods of treatment were rendered for patients with laryngotracheal stenosis. We share our experience with the combination total intravenous anaesthesia and apneic pause technique with or without steroid injection. Four cases of laryngotracheal stenosis were observed in Hospital Ampang: two adult and two paediatric cases. Age, gender, causative factor, stenosis segment length, grade or severity were observed before and after dilatation, number of dilatation were observed and compared. The outcome measures are decannulation and avoidance of tracheostomy. All cases had improvement of symptoms. Half or 50% of the patient required repeated balloon dilatations. The paediatric cases successfully avoided tracheostomy while the adult cases successfully decannulated with no complication from the procedure. Balloon dilatation by total intravenous anaesthesia coupled with apneic method is a safe and effective method of treatment for the narrowed airway.