Advertisement

Surgical and Radiologic Anatomy

, Volume 41, Issue 5, pp 543–550 | Cite as

Anatomical variations of anterior ethmoidal artery at the ethmoidal roof and anterior skull base in Asians

  • Baharudin AbdullahEmail author
  • Eng Haw Lim
  • Hazama Mohamad
  • Salina Husain
  • Mohd Ezane Aziz
  • Kornkiat Snidvongs
  • De Yun Wang
  • Kamarul Imran Musa
Original Article

Abstract

Purpose

The variations of the anterior ethmoidal artery (AEA) in different populations should be recognized by surgeons to prevent unwarranted complications during surgery. The aim of this study was to assess the anatomical variations of AEA in Asian population.

Methods

A cross-sectional study of 252 AEA identified by computed tomography (CT) of the paranasal sinuses. The multiplanar CT images were acquired from SOMATOM® Definition AS+ and reconstructed to axial, coronal and sagittal view at 1 mm slice thickness.

Results

42.5% of AEA was within skull base (grade I), 20.2% at skull base (grade II) and 37.3% coursed freely below skull base (grade III). The prevalence of supraorbital ethmoid cell (SOEC) and suprabullar cell (SBC) was 29.8% and 48.0%. The position of AEA at skull base has significant association with SOEC (p < 0.001), but not with SBC (p = 0.268). Type I Keros was 42.1% and Type 11 Keros was 57.9%. When lateral lamella’s height is longer, the probability increases for AEA to course freely within the ethmoid sinus (p = 0.016). The mean distance of AEA from skull base was 1.93 ± 2.03 mm, orbital floor 21.91 ± 2.47 mm and nasal floor 49.01 ± 3.53 mm.

Conclusions

The position of AEA at skull base depends on the presence of SOEC and length of lateral lamella, but not with SBC. When compared to European population, the mean distance between AEA and nasal floor is shorter in Asians.

Keywords

Anterior ethmoidal artery Ethmoid cell Suprabullar cell Supraorbital ethmoid cell Cribriform plate Skull base 

Notes

Author contributions

BA, MEA, HM and EHL: protocol/project development. BA, MEA, HM and EHL: data collection or management. BA, EHL, HM, MEA, KIM, SH, KS and DYW: data analysis. BA, EHL, HM, MEA, KIM, SH, KS and DYW: manuscript writing/editing.

Compliance with ethical standards

Conflict of interest

KS has been on the speakers’ bureau for Merck Sharp and Dohme, Glaxo Smith Kline and Mylan. All other authors have no financial disclosures or conflicts of interest.

References

  1. 1.
    Alazzawi S, Omar R, Rahmat K, Alli K (2012) Radiological analysis of the ethmoid roof in the Malaysian population. Auris Nasus Larynx 39:393–396CrossRefGoogle Scholar
  2. 2.
    Araujo Filho BC, Weber R, Pinheiro Neto CD, Lessa MM, Voegels RL, Butugan O (2006) Endoscopic anatomy of the anterior ethmoidal artery: a cadaveric dissection study. Rev Bras Otorrinolaringol (Engl Ed) 72:303–308CrossRefGoogle Scholar
  3. 3.
    Başak S, Karaman CZ, Akdilli A, Mutlu C, Odabaşi O, Erpek G (1998) Evaluation of some important anatomical variations and dangerous areas of the paranasal sinuses by CT for safer endonasal surgery. Rhinology 36:162–167Google Scholar
  4. 4.
    Cankal F, Apaydin N, Acar HI, Elhan A, Tekdemir I, Yurdakul M, Kaya M, Esmer AF (2004) Evaluation of the anterior and posterior ethmoidal canal by computed tomography. Clin Radiol 59:1034–1040CrossRefGoogle Scholar
  5. 5.
    Floreani SR, Nair SB, Switajewski MC, Wormald PJ (2006) Endoscopic anterior ethmoidal artery ligation: a cadaver study. Laryngoscope 116:1263–1267CrossRefGoogle Scholar
  6. 6.
    Gotwald TF, Menzler A, Beauchamp NJ, zur Nedden D, Zinreich SJ (2003) Paranasal and orbital anatomy revisited: identification of the ethmoid arteries on coronal CT scans. Crit Rev Comput Tomogr 44:263–278CrossRefGoogle Scholar
  7. 7.
    Jang DW, Lachanas VA, White LC, Kountakis SE (2014) Supraorbital ethmoid cell: a consistent landmark for endoscopic identification of the anterior ethmoidal artery. Otolaryngol Head Neck Surg 15:1073–1077CrossRefGoogle Scholar
  8. 8.
    Joshi AA, Shah KD, Bradoo RA (2010) Radiological correlation between the anterior ethmoidal artery and the supraorbital ethmoid cell. Indian J Otolaryngol Head Neck Surg 62:299–303CrossRefGoogle Scholar
  9. 9.
    Kainz J, Stammberger H (1988) The roof of the anterior ethmoid: a locus minoris resistentiae in the skull base. Laryngol Rhinol Otol 67:142–149CrossRefGoogle Scholar
  10. 10.
    Keros P (1962) On the practical value of differences in the level of the lamina cribrosa of the ethmoid. Z Laryngol Rhinol Otol Ihre Grenzgeb 41:808–813Google Scholar
  11. 11.
    Lannoy-Penisson L, Schultz P, Riehm S, Atallah I, Veillon F, Debry C (2007) The anterior ethmoidal artery: radio-anatomical comparison and its application in endonasal surgery. Acta Otolaryngol 127:618–622CrossRefGoogle Scholar
  12. 12.
    Lee WC, Ming Ku PK, van Hasselt CA (2000) New guidelines for endoscopic localization of the anterior ethmoidal artery: a cadaveric study. Laryngoscope 110:1173–1178CrossRefGoogle Scholar
  13. 13.
    Loury MC (1993) Endoscopic frontal recess and frontal sinus ostium dissection. Laryngoscope 103:455–458CrossRefGoogle Scholar
  14. 14.
    McDonald SE, Robinson PJ, Nunez DA (2008) Radiological anatomy of the anterior ethmoidal artery for functional endoscopic sinus surgery. J Laryngol Otol 122:264–267CrossRefGoogle Scholar
  15. 15.
    Monjas-Cánovas I, García-Garrigós E, Arenas-Jiménez JJ, Abarca-Olivas J, Sánchez-Del Campo F, Gras-Albert JR (2011) Radiological anatomy of the ethmoidal arteries: CT cadaver study. Acta Otorrinolaringol Esp 62:367–374CrossRefGoogle Scholar
  16. 16.
    Moon HJ, Kim HU, Lee JG, Chung IH, Yoon JH (2001) Surgical anatomy of the anterior ethmoidal canal in ethmoid roof. Laryngoscope 111:900–904CrossRefGoogle Scholar
  17. 17.
    Noori FM, Ali MA, Karim R, Mandal SK, Omar S, Ali MG (2017) Observation of anterior ethmoidal artery in coronal CT scans of paranasal sinuses in patients attending Katihar Medical College, Katihar. Ann Int Med Den Res 3:4–6CrossRefGoogle Scholar
  18. 18.
    Poteet PS, Cox MD, Wang RA, Fitzgerald RT, Kanaan A (2017) Analysis of the relationship between the location of the anterior ethmoid artery and Keros classification. Otolaryngol Head Neck Surg 157:320–324CrossRefGoogle Scholar
  19. 19.
    Sacks R, Kalish L (2008) Endoscopic approach after failure of open sinus procedures. In: Revision sinus surgery. Springer, Berlin, pp 337–346CrossRefGoogle Scholar
  20. 20.
    Simmen D, Raghavan U, Briner HR, Manestar M, Schuknecht B, Groscurth P, Jones NS (2006) The surgeon’s view of the anterior ethmoidal artery. Clin Otolaryngol 31:187–191CrossRefGoogle Scholar
  21. 21.
    Siow JK (2016) The “Mesentery” of the anterior ethmoid artery. Ann Otolaryngol Rhinol 3:1084Google Scholar
  22. 22.
    Souza SA, de Souza MM, Idagawa M, Wolosker AM, Ajzen S (2008) Computed tomography assessment of the ethmoid roof: a relevant region at risk in endoscopic sinus surgery. Radiol Bras 4:143–147CrossRefGoogle Scholar
  23. 23.
    Souza SA, Souza MM, Gregório LC, Ajzen S (2009) Anterior ethmoidal artery evaluation on coronal CT scans. Braz J Otorhinolaryngol 75:101–106CrossRefGoogle Scholar
  24. 24.
    Stammberger H, Posawetz W (1990) Functional endoscopic sinus surgery. Concept, indications and results of the Messerklinger technique. Eur Arch Otorhinolaryngol 247:63–76CrossRefGoogle Scholar
  25. 25.
    Stammberger H, Lund VJ (2008) Anatomy of the nose and paranasal sinuses. In: Scott-Brown’s otorhinolaryngology: head and neck surgery 7th edn, vol 2. CRC Press, Boca Raton. p 1335Google Scholar
  26. 26.
    Wuttiwongsanon C, Chaowanapanja P, Harvey RJ, Sacks R, Schlosser RJ, Chusakul S, Aeumjaturapat S, Snidvongs K (2015) The orbital floor is a surgical landmark for the Asian anterior skull base. Am J Rhinol Allergy 29:216–219CrossRefGoogle Scholar
  27. 27.
    Yang YX, Lu QK, Liao JC, Dang RS (2009) Morphological characteristics of the anterior ethmoidal artery in ethmoid roof and endoscopic localization. Skull Base 19:311–317CrossRefGoogle Scholar
  28. 28.
    Yenigun A, Goktas SS, Dogan R, Eren SB, Ozturan O (2016) A study of the anterior ethmoidal artery and a new classification of the ethmoid roof (Yenigun classification). Eur Arch Otorhinolaryngol 273:3759–3764CrossRefGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Otorhinolaryngology-Head and Neck Surgery, School of Medical SciencesUniversiti Sains Malaysia Health CampusKubang KerianMalaysia
  2. 2.Department of Otorhinolaryngology-Head and Neck SurgeryUniversiti Kebangsaan Malaysia Medical CentreBandar Tun RazakMalaysia
  3. 3.Department of Radiology, School of Medical SciencesUniversiti Sains MalaysiaKubang KerianMalaysia
  4. 4.Department of Otolaryngology Head and Neck Surgery, Faculty of MedicineChulalongkorn University and King Chulalongkorn Memorial HospitalBangkokThailand
  5. 5.Department of Otolaryngology, Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
  6. 6.Department of Community Medicine, School of Medical SciencesUniversiti Sains Malaysia Health CampusKubang KerianMalaysia

Personalised recommendations