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Analysis of anatomical variation of the inclination of lamellas attached to the skull base and its correlation with the anterior ethmoidal artery floating in the ethmoid sinus for use in endoscopic sinus surgery

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Abstract

Purpose

Attention to the inclination of lamellas attached to the skull base, including the basal lamella of the middle turbinate, facilitates the intraoperative identification of each lamella without requiring the use of a navigation system. We classified the inclination between the lamella and the skull base in preoperative computed tomography (CT) images and examined the relationship between the lamellas attached to the skull base, including the basal lamella of the middle turbinate, and the position of the anterior ethmoidal artery (AEA). We aimed to develop a preoperative classification to help prevent intraoperative injury of the AEA.

Methods

We retrospectively investigated the paranasal sinus sagittal section CT slices of 366 sides of 183 patients to assess the inclination of lamellas attached to the skull base and the AEA location. We also reviewed the AEA position, its correlation with the supraorbital ethmoid cell, and the lateral lamella of the cribriform plate.

Results

We classified the lamella inclination at the skull base as the anterior direction, perpendicular direction, and posterior direction types. Lamellas containing a floating AEA inclined in the anterior direction toward the skull base were observed in 68.9% of sides, inclination in the perpendicular direction was noted in 30.5% of sides, and inclination in the posterior direction was noted in 0.5% of sides.

Conclusion

It is easier to identify the AEA intraoperatively when the lamella inclination of the skull base attachment is recognized based on preoperative CT findings. This approach could be applied to all paranasal sinus lamellas and assist in identifying the AEA and other nearby structures.

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Funding

The authors declare that this study did not receive external funding.

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Authors and Affiliations

  1. Department of Otorhinolaryngology, The Jikei University School of Medicine, 3-19-18 Nishi-shinbashi, Minato-ku, Tokyo, 105-8471, Japan

    Teppei Takeda, Kazuhiro Omura & Nobuyoshi Otori

  2. Department of Otorhinolaryngology, Toho University Omori Medical Center, 6-11-1, Omori-Nishi, Ota-ku,, Tokyo, 143-8541, Japan

    Teppei Takeda, Riko Kajiwara & Kota Wada

Authors
  1. Teppei Takeda
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  2. Riko Kajiwara
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  3. Kazuhiro Omura
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  4. Nobuyoshi Otori
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  5. Kota Wada
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Contributions

TT: protocol development, data collection, data analysis, manuscript writing. KO: protocol development. RK: data collection, manuscript editing. NO: manuscript editing. KW: protocol development, manuscript editing.

Corresponding author

Correspondence to Kazuhiro Omura.

Ethics declarations

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation and with the Helsinki Declaration of 1975.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Toho University Omori Medical Center Institutional Review Board (approval no.: M18112) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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The requirement for informed consent was waived due to the retrospective nature of the study.

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Takeda, T., Kajiwara, R., Omura, K. et al. Analysis of anatomical variation of the inclination of lamellas attached to the skull base and its correlation with the anterior ethmoidal artery floating in the ethmoid sinus for use in endoscopic sinus surgery. Surg Radiol Anat 42, 995–1002 (2020). https://doi.org/10.1007/s00276-020-02474-y

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