Endoscopic anatomy of the anterior ethmoidal artery: A cadaveric dissection study

Department of Otorhinolaryngology, University Hospital, Medical School of the University of São Paulo, Brazil.
Brazilian journal of otorhinolaryngology (Impact Factor: 0.65). 05/2006; 72(3):303-8. DOI: 10.1016/S1808-8694(15)30961-7
Source: PubMed


The anterior ethmoidal artery (AEA) is an important point of anatomical reference in order to locate the frontal sinus and the skull base. Notwithstanding, despite numerous endoscopic studies in cadavers, we still lack an anatomical study on the AEA in the western population.
to determine reference points used to locate the artery, study its relationship with the skull base and its degree of dehiscence, as well as to study intra and inter individual variations.
we dissected the nasal fossae belonging to 25 cadavers.
the average intranasal length of the anterior ethmoidal artery was 5.2 mm. The anterior ethmoidal canal presented some degree of dehiscence in 66.7%. The average distance between the artery middle point to the anterior nasal spine was of 61.72 mm (sd=4.18 mm); to the lateral nasal wall (nasal axilla) was of 64.04 mm (sd=4.69 mm); and from the anterior axilla to the middle turbinate was of 21.14 mm (sd=3.25 mm). For all the measures there was no statistically significant measures when both sides were compared (p>0.05).
We concluded that the middle conchae axilla is the most reliable point of reference to locate the AEA.

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Available from: Marcus Miranda Lessa, Apr 24, 2014
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    • "Moon et al. [10] ont e ´ tudié la distance entre l'artè re ethmoı¨dale anté rieure et le seuil nasal (49 mm). Filho et al. [2] ont repé ré l'artè re ethmoı¨dale anté rieure par rapport a ` l'e ´ pine nasal (61 mm) et par rapport a ` la jonction du cornet moyen a ` la paroi laté rale de la cavité nasale (21 mm). Simmen et al. [13] ont mesuré la distance entre artè re ethmoı¨dale anté rieure et paroi posté rieure de l'ostium du sinus frontal (6–15 mm). "
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    ABSTRACT: The anterior ethmoidal artery represents a major danger in the dissection of the anterior ethmoid roof. In addition to hemorrhage, its injury exposes the patient to the risk of orbital haematoma and requires intraoperative and postoperative vigilance. The goal of this study was to describe the anatomical relationship between the frontal sinus ostium and the anterior ethmoidal artery, such as they are observed with the endoscope during nasalization. Consecutive patients with no surgical history or agenesia of the frontal sinuses, with an indication for ethmoidal complete exenteration with ablation of the mucous membrane (nasalization), were included in a prospective descriptive study. When dissection of the anterior ethmoidal roof was finished, the relationship between the frontal sinus ostium and the anterior ethmoidal artery were filmed and drawn on a diagram during surgery. A photograph of the relationship between the frontal sinus ostium and anterior ethmoidal artery was selected afterward from the film. Sixty-eight ethmoids were operated (30 bilateral, eight unilateral) with no complications. The anterior ethmoidal artery was visible in 60 cases (88%), 31 out of 34 cases on the left side (45%) and 29 out of 34 cases on the right side (43%); it was not visible in eight cases (12%), three cases on the left (4.5%) and five cases on the right (7.5%). In the most frequent anatomical configuration (45 cases, 66%), the frontal sinus ostium was separated from the anterior ethmoidal artery by a single ethmoidal cell. The other anatomical configurations were: presence of two cells between the frontal sinus ostium and the anterior ethmoidal artery in 11 cases (16%), and three cells in one case (1%) or absence of the ethmoidal cell between the frontal sinus ostium and the anterior ethmoidal artery (the anterior ethmoidal artery was located on the posterior wedge of the frontal ostium) in three cases (4%). The comparison of the 30 bilateral cases showed a symmetrical relationship between the frontal sinus ostium and the anterior ethmoidal artery in 20 cases (67%). These data are addressed to surgeons seeking the anterior ethmoidal artery starting from the frontal sinus ostium. Localization of the frontal sinus ostium, which can be achieved by retrograde cannulation of the frontal sinus or using a transcutaneous frontal drain, appears to be a reliable technique to dissect the roof of the anterior ethmoid and locate the anterior ethmoidal artery.
    Annales d Otolaryngologie et de Chirurgie Cervico-Faciale 10/2008; 125(4):174-80. DOI:10.1016/j.aorl.2008.07.002
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    Radiologia Brasileira 06/2008; 41(3). DOI:10.1590/S0100-39842008000300003
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    ABSTRACT: OBJETIVO: Avaliar a profundidade das fossas olfatórias e a freqüência de assimetria na altura e na inclinação lateral do contorno do teto etmoidal. MATERIAIS E MÉTODOS: Estudo retrospectivo de 200 tomografias computadorizadas dos seios da face no plano coronal realizadas no período de agosto a dezembro de 2006. As profundidades das fossas olfatórias foram classificadas segundo Keros. O teto etmoidal foi avaliado quanto à simetria entre os lados. RESULTADOS: O tipo de Keros mais encontrado foi o tipo II (73,3%), seguido do tipo I (26,3%) e do tipo III (0,5%). Em 12% (24 exames) havia assimetria entre os lados quanto à altura do teto etmoidal, e em 48,5% (97 exames) observou-se assimetria do contorno do teto, com inclinação lateral da lâmina crivosa de um dos lados. CONCLUSÃO: Em relação à profundidade das fossas olfatórias, o tipo II de Keros foi o mais freqüente. Verificou-se que a assimetria do teto do seio etmoidal, na maioria dos casos, estava relacionada com a inclinação lateral da lamela lateral da lâmina crivosa.
    Radiologia Brasileira 06/2008; 41(3):143-147.
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