![]() Preoperative identification of the AEA and its variations on CT scans reduces the risk of iatrogenic injury and is important for safe and effective FESS. Many studies have provided guidelines to better facilitate AEA identification and localisation preoperatively and during surgical procedures. Iatrogenic injury of the AEA could result in intra-orbital bleeding, profuse epistaxis, a retro-orbital haematoma (that may lead to blindness if not decompressed within one hour), intracranial bleeding (in rare cases), and cerebrospinal fluid leaks. Detailed anatomical knowledge pertaining to the AEA and its possible variations is crucial to avoid complications during surgery. The segment of the AEA that traverses the anterior ethmoidal sinus is the most vulnerable during surgery, hence surgeons need to be aware of variations. Its position may even vary on either side of the same individual. The AEA displays significant variability as it traverses the anterior ethmoidal sinus from the orbit to the LLCP. A preoperative computed tomography (CT) scan is necessary to evaluate the complex anatomy of the AEA. Its deep situation, complicated relations (with vital structures such as the lamina papyracea, SB, olfactory fossa, and frontal recess), and extensive variations make it a high-risk territory for surgeons. The AEA is a major anatomical landmark that is susceptible to accidental injury during surgery of the frontal sinus, frontal recess, anterior ethmoidal sinus, and SB. Additionally, its identification helps to define and treat cases of severe epistaxis and it serves as a useful landmark for the endoscopic drainage of orbital abscesses and evacuation of orbital haematomas. ![]() Localisation of the vessel also aids surgical management of anterior naso-septal perforations through the utilisation of unilateral mucosal flaps based on the AEA and its branches. In external approaches, identification of the AEA in the fronto-ethmoidal suture marks the anterior border of the anterior cranial fossa. However, the variable location of the artery complicates endoscopic surgery of the frontal recess. Localisation of the AEA is important for frontal FESS, particularly during preoperative radiological evaulations. During frontal recess surgeries, the AEA marks the posterior border of the recess. The AEA is an important landmark in FESS, used to locate the frontal sinus, frontal recess, and anterior SB. Advancements in endoscopic technologies, instrumentation, and imaging modalities have allowed FESS to be applied not only to the nasal cavity and paranasal sinuses but also to the orbit and SB. įunctional endoscopic sinus surgery (FESS) is one of the most commonly performed procedures by otorhinolaryngologists. The AEA supplies the frontal and ethmoidal sinuses, as well as the roof of the nose and nasal septum. The AEA then turns anteriorly, forming a groove in the LLCP known as the anterior ethmoidal sulcus, to reach the nose via the cribriform plate. It traverses the roof/ethmoidal complex anteromedially, before entering the anterior cranial fossa (olfactory fossa) via the lateral lamella of the cribriform plate (LLCP) or the point at which the frontal bone connects to the LLCP. The artery crosses the complex at the level of its roof (skull base ) or below this level, by as much as 5 mm, in a mesentery or thin bony lamella. The anterior ethmoidal foramen opens into the anterior ethmoidal canal, which transmits the artery through the anterior ethmoidal sinus/complex. It passes between the superior oblique and medial rectus eye muscles before leaving the orbit via the anterior ethmoidal foramen (situated in the fronto-ethmoidal suture). The anterior ethmoidal artery (AEA) originates from the ophthalmic artery in the orbit.
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