New Guidelines for Endoscopic Localization of the Anterior Ethmoidal Artery: A Cadaveric Study

• Published in: The Laryngoscope 2000, Vol.110 (7), p.1173-1178
• Main Authors: Lee, Wai Chung, Ming Ku, Peter Ka, van Hasselt, Charles Andrew
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; anatomy; Anterior ethmoidal artery; Arteries - anatomy & histology; Biological and medical sciences; Endoscopy; Endoscopy - methods; Ent; Ethmoid Sinus - anatomy & histology; Ethmoid Sinus - blood supply; Female; Guidelines as Topic; Head and neck surgery. Maxillofacial surgery. Dental surgery. Orthodontics; Humans; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the upper aerodigestive tract
• ISSN: 0023-852X; 1531-4995
• DOI: 10.1097/00005537-200007000-00020

Objectives To determine objective data to improve the methods of identification of the anterior ethmoidal artery during endoscopic dissection. Study Design Cadaveric dissection of adult human heads. Methods A 0°, 4‐mm rigid endoscope was used to guide uncinectomy and frontoethmoidectomy. The location of the anterior ethmoidal artery was first determined visually and then confirmed by passing a needle through the anterior ethmoidal foramen from the orbit into the nose in all cases. The distances were endoscopically measured using a simple ruler between two nasal landmarks and the anterior ethmoidal artery. Results Fifty‐six nasal fossae in 28 cadavers were dissected endoscopically. The median distance between the artery and the “axilla” formed by the anterior attachment of the middle turbinate to the lateral nasal wall was 20 mm (range, 17–25 mm), irrespective of the side. The measurement differed by less than 2 mm between the sides in the same individual. The median distance between the artery and the “axilla” formed by the medial and lateral crura of the lower lateral cartilage (superomedial edge of the nostril) was 62 mm (range, 55–75 mm) for both sides. The artery was found to be in direct alignment with the two “axillae” formed by the middle turbinate and the nostril edge. Conclusions The distance between the ethmoidal artery and the axilla of the middle turbinate showed the least intraindividual and interindividual variations. The tip of the endoscope (or the ruler) points directly at the anterior ethmoidal artery in the fovea ethmoidalis when its edge is aligned with the two nasal landmarks. These simple guidelines can aid the identification of the artery in endoscopic frontoethmoidectomy.