Anatomical variations of anterior ethmoidal artery and their significance in endoscopic sinus surgery: a systematic review
- 208 Downloads
Anterior ethmoidal artery (AEA) is at risk of injury in endoscopic sinus surgery due to its location. The aim of this review was to assess the anatomical variations of AEA and their significance.
A literature search was performed on PUBMED, SCOPUS AND EMBASE. The following keywords were used: ethmoidal artery; anterior ethmoidal artery; anterior ethmoidal canal; ethmoid sinus; ethmoid roof; skull base. The search was conducted over a period of 6 months between October 2016 and April 2017.
105 articles were retrieved. 76 articles which were either case reports or unrelated topics were excluded. Out of the 29 full text articles retrieved, 16 articles were selected; 3 were cadaveric dissection, 5 combined cadaveric dissection and computed tomography (CT) and the rest were of CT studies. All studies were of level III evidence and a total of 1985 arteries were studied. Its position at the skull base was influenced by the presence of supraorbital ethmoid cell (SOEC) and length of the lateral lamella of cribriform plate (LLCP). Inter population morphological variations contribute to the anatomical variations.
The average diameter of AEA was 0.80 mm and the intranasal length was 5.82 mm. 79.2% was found between the second and third lamellae, 12.0% in the third lamella, 6% posterior to third lamella and 1.2% in the second lamella. Extra precaution should be taken in the presence of a well-pneumatized SOEC and a long LLCP as AEA tends to run freely below skull base.
KeywordsAnterior skull base Endoscopic sinus surgery Sinus anatomy Skull base Endoscopic skull base surgery
BA and EHL: protocol/project development. BA and EHL: data collection or management. BA, EHL, SH, KS and DYW: data analysis. BA, EHL, SH, KS and DYW: manuscript writing/editing.
Compliance with ethical standards
Conflict of interest
K. S. has been on the speakers’ bureau for Merck Sharp & Dohme, Glaxo Smith Kline and Mylan. All other authors have no financial disclosures or conflicts of interest.
- 1.Adeel M, Ikram M, Rajput MS et al (2013) Asymmetry of lateral lamella of the cribriform plate: a software-based analysis of coronal computed tomography and its clinical relevance in endoscopic sinus surgery. Surg Radiol Anat 35:843–847. https://doi.org/10.1007/s00276-013-1106-4 CrossRefGoogle Scholar
- 3.Basak S, Karamam CZ, Akdilli A et al (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
- 10.Higgins JPT, Green S (eds) (2011) Cochrane handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, LondonGoogle Scholar
- 15.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
- 18.Lund VJ, Stammberger H, Fokkens WJ et al (2014) European position paper on the anatomical terminology of the internal nose and paranasal sinuses. Rhinol Suppl 24:1–34Google Scholar
- 25.Park SS, Yoon BN, Cho KS et al (2010) Pneumatization pattern of the frontal recess: Relationship of the anterior-to-posterior length of frontal isthmus and/or frontal recess with the volume of agger nasi cell. Clin Exp Otorhinolaryngol 3:76–83. https://doi.org/10.3342/ceo.2010.3.2.76 CrossRefGoogle Scholar
- 29.Siow JK (2016) The “mesentery” of the anterior ethmoid artery. Ann Otolaryngol Rhinol 3:1084Google Scholar
- 32.Stammberger H, Lund VJ (2008) Anatomy of the nose and paranasal sinuses. In: Gleeson M, Browning GG, Burton MJ et al (eds) Scott–Brown’s otorhinolaryngology: head and neck surgery, 7th edn. Hodder Arnold, London, p 1335Google Scholar