What is the relationship between the anterior ethmoid artery and the ethmoid bulla during endoscopic sinus surgery?

From the Guidelines

The anterior ethmoid artery's relationship with the ethmoid bulla is crucial during endoscopic sinus surgery, but the provided evidence does not specifically describe this relationship. When considering the anatomy relevant to endoscopic sinus surgery, it's essential to understand the structures involved, including the nasal valves, uncinate process, infundibulum, hiatus semilunaris, ethmoid bulla, and frontal recess, as well as the entire ostiomeatal unit 1. The ostiomeatal unit consists of an area including the middle meatus, uncinate process, infundibulum, anterior ethmoid cells, and ostia of the maxillary, ethmoid, and frontal sinuses, which is important for surgeons to be familiar with during procedures like functional endoscopic sinus surgery (FESS) 1. Key points to consider in this context include:

• The importance of understanding detailed anatomy for successful surgical outcomes
• The role of training and observation in mastering endoscopic techniques
• The potential risks associated with surgical procedures in this area, such as vascular injury or damage to surrounding structures. Given the lack of specific information on the anterior ethmoid artery's relationship to the ethmoid bulla in the provided study, surgeons should rely on the most current and detailed anatomical studies to inform their practice, prioritizing caution and meticulous technique to avoid complications during endoscopic sinus surgery.

From the Research

Relationship between Anterior Ethmoid Artery and Ethmoid Bulla

The relationship between the anterior ethmoid artery and the ethmoid bulla is crucial during endoscopic sinus surgery.

• The anterior ethmoidal artery (AEA) is usually identified as it traverses obliquely across the fovea ethmoidalis, posterior to the bulla ethmoidalis and anterior to or within the ground lamella's attachment to the skull base 2.
• However, anatomical variations can occur, and the AEA may be located anterior to the bulla ethmoidalis, as seen in a case of Waardenburg's syndrome 2.
• Understanding the endoscopic locations of the ethmoid arteries is important during endoscopic sinus or endoscopic skull base procedures to avoid injury 3.
• The AEA can be referenced to the axilla of the middle turbinate, and its location can vary in relation to the superior attachment of the basal lamella 3.
• A consistent endoscopic landmark for the AEA has been described as the septation or ridge one step back along the ethmoid skull base from the posterior table of the frontal sinus 4.
• Anatomical variations of the AEA can be influenced by the presence of a supraorbital ethmoid cell and the length of the lateral lamella of the cribriform plate 5.
• Ethmoid pneumatization can affect the location of the AEA, with increased pneumatization resulting in a greater distance between the AEA and the frontonasal junction or the lateral attachment of the inferior turbinate 6.

Clinical Significance

• Injury to the AEA can result in hemorrhage, retraction of the AEA into the orbit, and a retrobulbar hematoma, which can threaten vision 2.
• Awareness of potential anatomic anomalies in patients with abnormal craniofacial development is essential for endoscopic sinus surgeons 2.
• Using the lamellae to locate the AEA is a reliable method, as increased pneumatization of the ethmoid cavity does not affect AEA localization in terms of the lamellae 6.
• Extra precaution should be taken in the presence of a well-pneumatized supraorbital ethmoid cell and a long lateral lamella of the cribriform plate, as the AEA tends to run freely below the skull base 5.