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Relation between anterior ethmoidal artery course on computed tomography and supraorbital ethmoid cell and Keros classification

  • Rhinology
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Abstract

Purpose

The anterior ethmoidal artery (AEA) is an important risk area in endoscopic sinus surgery. This study aimed to evaluate the course of AEA according to the Keros classification and the presence of supraorbital ethmoid cell (SOEC) and to prevent possible complications by emphasizing the importance of preoperative paranasal computed tomography (CT) imaging. This approach will increase the effectiveness of endoscopic sinus surgery and improve patient safety.

Methods

The paranasal CT scan images of patients aged > 18 years between October 2020 and November 2021 from our center were retrospectively analyzed. The images were primarily evaluated in the coronal plane, and the sagittal and axial planes were utilized to evaluate variations in AEA regarding the skull base. Furthermore, the relation of AEA course with Keros classification and SOEC was evaluated. The study included 1000 patients aged 18–80 years (right and left, a total of 2000 samples).

Results

Grade 3 AEA was the most common regarding the skull base. Keros Type 2 was the most common classification. Overall, 48.7% patients had SOEC. The incidence of Grade 3 AEA was higher among patients with SOEC and a higher Keros classification compared with those without SOEC and a lower Keros classification. Furthermore, Keros Type 3 was the most associated with SOEC presence.

Conclusion

Consistent with the literature, the probability of Grade 3 AEA in patients with high Keros classification and SOEC was significantly higher in our study. Therefore, we consider that preoperative imaging according to Keros classification and SOEC presence can predict AEA course and guide surgery.

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Data availability

All data generated or analysed during this study are included in this published article.

References

  1. Meccariello G, Deganello A, Choussy O et al (2016) Endoscopic nasal versus open approach for the management of sinonasal adenocarcinoma: a pooled-analysis of 1826 patients. Head Neck 38(Suppl 1):E2267-2274. https://doi.org/10.1002/hed.24182

    Article  PubMed  Google Scholar 

  2. Karkos PD, Fyrmpas G, Carrie SC, Swift AC (2006) Endoscopic versus open surgical interventions for inverted nasal papilloma: a systematic review. Clin Otolaryngol 31(6):499–503. https://doi.org/10.1111/j.1365-2273.2006.01333.x

    Article  CAS  PubMed  Google Scholar 

  3. Ramakrishnan VR, Kingdom TT, Nayak JV, Hwang PH, Orlandi RR (2012) Nationwide incidence of major complications in endoscopic sinus surgery. Int Forum Allergy Rhinol 2(1):34–39. https://doi.org/10.1002/alr.20101

    Article  PubMed  Google Scholar 

  4. Moon H, Kim H, Lee J, Chung I, Yoon JH (2001) Surgical anatomy of the anterior ethmoidal canal in ethmoid roof. Laryngoscope 111:900–904. https://doi.org/10.1097/00005537-200105000-00027

    Article  CAS  PubMed  Google Scholar 

  5. McDonald SE, Robinson PJ, Nunez DA (2008) Radiological anatomy of the anterior ethmoidal artery for functional endoscopic sinus surgery. J Laryngol Otol 122(3):264–267. https://doi.org/10.1017/S0022215107008158

    Article  CAS  PubMed  Google Scholar 

  6. Naunheim MR, Sedaghat AR, Lin DT et al (2015) Immediate and delayed complications following endoscopic skull base surgery. J Neurol Surg Part B Skull Base 76(5):390–396. https://doi.org/10.1055/s-0035-1549308

    Article  Google Scholar 

  7. Stankiewicz JA, Chow JM (1999) Two faces of orbital hematoma in intranasal (endoscopic) sinus surgery. Otolaryngol-Head Neck Surg 120(6):841–847. https://doi.org/10.1016/S0194-5998(99)70324-4

    Article  CAS  PubMed  Google Scholar 

  8. Keros P (1962) On the practical value of differences in the level of the lamina cribrosa of the ethmoid. Z Laryngol Rhinol Otol 41:809–813

    CAS  PubMed  Google Scholar 

  9. Jacob TG, Kaul JM (2014) Morphology of the olfactory fossa – a new look. J Anat Soc India 63(1):30–35. https://doi.org/10.1016/j.jasi.2014.04.006

    Article  Google Scholar 

  10. 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 151(6):1073–1077. https://doi.org/10.1177/0194599814551124

    Article  PubMed  Google Scholar 

  11. 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(3):299–303. https://doi.org/10.1007/s12070-010-0088-3

    Article  PubMed  PubMed Central  Google Scholar 

  12. Gotwald TF, Zinreich SJ, Corl F, Fishman EK (2001) Three-dimensional volumetric display of the nasal ostiomeatal channels and paranasal sinuses. Am J Roentgenol 176(1):241–245. https://doi.org/10.2214/ajr.176.1.1760241

    Article  CAS  Google Scholar 

  13. 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 (Stockh) 127(6):618–622. https://doi.org/10.1080/00016480600987826

    Article  CAS  PubMed  Google Scholar 

  14. Ko YB, Kim MG, Jung YG (2014) The anatomical relationship between the anterior ethmoid artery, frontal sinus, and intervening air cells; can the artery be useful landmark? Korean J Otorhinolaryngol-Head Neck Surg 57(10):687–691

    Article  Google Scholar 

  15. Standring S (2021) Gray’s anatomy E-book: the anatomical basis of clinical practice. Elsevier Health Sciences

    Google Scholar 

  16. Abdullah B, Chew SC, Aziz ME et al (2020) A new radiological classification for the risk assessment of anterior skull base injury in endoscopic sinus surgery. Sci Rep 10(1):4600. https://doi.org/10.1038/s41598-020-61610-1

    Article  ADS  CAS  PubMed  PubMed Central  Google Scholar 

  17. Başak H, Karaman C, Akdilli A, Mutlu C, Odabasi O, Erpek G (1999) Evaluation of some important anatomical variations and dangerous areas of the paranasal sinuses by CT for safer endonasal surgery. Rhinology 36:162–167

    Google Scholar 

  18. Cankal F, Apaydin N, Acar HI et al (2004) Evaluation of the anterior and posterior ethmoidal canal by computed tomography. Clin Radiol 59(11):1034–1040. https://doi.org/10.1016/j.crad.2004.04.016

    Article  CAS  PubMed  Google Scholar 

  19. Simmen D, Raghavan U, Briner HR et al (2006) The surgeon’s view of the anterior ethmoid artery. Clin Otolaryngol 31(3):187–191. https://doi.org/10.1111/j.1365-2273.2006.01191.x

    Article  CAS  PubMed  Google Scholar 

  20. 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(11):3759–3764. https://doi.org/10.1007/s00405-016-4064-8

    Article  PubMed  Google Scholar 

  21. 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 Neck Surg 157(2):320–324. https://doi.org/10.1177/0194599817696302

    Article  Google Scholar 

  22. Sjogren PP, Waghela R, Ashby S, Wiggins RH, Orlandi RR, Alt JA (2017) International frontal sinus anatomy classification and anatomic predictors of low-lying anterior ethmoidal arteries. Am J Rhinol Allergy 31(3):174–176. https://doi.org/10.2500/ajra.2017.31.4428

    Article  PubMed  Google Scholar 

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Funding

The authors did not receive support from any organization for the submitted work.

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Authors and Affiliations

  1. Department of Radiology, Health Sciences University Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey

    Tarık Sağlam

  2. Department of Radiology, Dicle University Medical Faculty, Sur, Diyarbakır, Turkey

    Muhammed Akif Deniz, Mehmet Turmak, Salih Hattapoğlu, İbrahim Akbudak & Muhammed Tekinhatun

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  1. Tarık Sağlam
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  2. Muhammed Akif Deniz
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  4. Salih Hattapoğlu
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Contributions

MAD, İA, MT: Project development, Data Collection, Manuscript writing, MT, TS, SH: Data collection, Manuscript writing, TS, MAD: Statistical analysis.

Corresponding author

Correspondence to Muhammed Akif Deniz.

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The authors have no competing interests to declare that are relevant to the content of this article.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This study was approved by the local ethics committee (Non-Invasive Clinical Research Ethics Committee, XX University Faculty of Medicine; Date: 12.05.2022 Number: 125).

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Informed consent was obtained from all individual participants included in the study.

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Sağlam, T., Deniz, M.A., Turmak, M. et al. Relation between anterior ethmoidal artery course on computed tomography and supraorbital ethmoid cell and Keros classification. Eur Arch Otorhinolaryngol 281, 1293–1299 (2024). https://doi.org/10.1007/s00405-023-08286-1

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