scholarly journals Anterior Ethmoidal Artery Emerging Anterior to Bulla Ethmoidalis: An Abnormal Anatomical Variation in Waardenburg's Syndrome

2014 ◽  
Vol 5 (3) ◽  
pp. ar.2014.5.0094 ◽  
Author(s):  
Danny K. C. Wong ◽  
Angus Shao ◽  
Raewyn Campbell ◽  
Richard Douglas
Keyword(s):  
Anatomical Variation ◽  
Vascular Anatomy ◽  
Sinus Surgery ◽  
Facial Features ◽  
Retrobulbar Hematoma ◽  
Ethmoidal Artery ◽  
Anterior Ethmoidal Artery ◽  
Craniofacial Features ◽  
The Right ◽  
Tomography Scan

In 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. Injury to the AEA may result in hemorrhage, retraction of the AEA into the orbit, and a retrobulbar hematoma. The resulting increase in intraorbital pressure may threaten vision. Waardenburg's syndrome (WS) is a rare congenital, autosomal dominantly inherited disorder, distinguished by characteristic facial features, pigmentation abnormalities, and profound, congenital, sensorineural hearing loss. We present a case of AEAs located anterior to the bulla ethmoidalis in a 36-year-old male with WS and chronic rhinosinusitis. The anatomic abnormality was not obvious on a preoperative computed tomography scan and was discovered intraoperatively when the left AEA was injured, resulting in a retrobulbar hematoma. The hematoma was immediately identified and decompressed endoscopically without lasting complications. The AEA on the right was identified intraoperatively and preserved. The characteristic craniofacial features in WS were probably associated with the abnormal vascular anatomy. Endoscopic sinus surgeons should be aware of these potential anatomic anomalies in patients with abnormal craniofacial development.

scholarly journals Variability of the Anterior Ethmoid Artery in Endoscopic Sinus Surgery

2020 ◽  
pp. 014556132095048
Author(s):  
Mohamed A. Taha ◽  
Christian A. Hall ◽  
Harry E. Zylicz ◽  
Margaret B. Westbrook ◽  
William T. Barham ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Skull Base ◽  
Statistical Significance ◽  
Sinus Surgery ◽  
Preoperative Imaging ◽  
Computed Tomography Scans ◽  
Ethmoidal Artery ◽  
Anterior Ethmoidal Artery ◽  
The Right ◽  
Anterior Ethmoid Artery

Introduction: The anterior ethmoidal artery (AEA) demonstrates anatomic variability relative to its descent from the anterior skull base. Our study’s objective was to assess for correlation of AEA descent and laterality, in addition to correlation of AEA descent and the presence of supraorbital ethmoid cells (SOEC) and concha bullosae (CB). Method: A retrospective study was performed at a tertiary rhinology center from January 2019 to January 2020. Noncontrast maxillofacial computed tomography scans were examined independently by 2 fellowship trained rhinologists. The vertical distance from both left and right AEAs to the ipsilateral skull base were compared and correlated with the presence of ipsilateral SOEC and CB. Results: Computed tomography scans from 50 subjects were included. Mean age was 50.68 years (40% females). The distance of AEA to the skull base was greater on the left when compared to the right (62% vs 48%) ( P < .05). The left AEA had an average descent of 2.84 mm versus 1.78 mm on the right ( P < .05). An SOEC was present in 56% of cases. Thirty-eight percent of subjects had both SOEC and AEA descent on the right, while 52% of subjects had both on the left. This reached a statistical significance on both sides ( P < .05). Concha bullosa was present in 35% of cases, with both AEA descent and CB present in 16% on the right, and 32% on the left. Conclusion: The AEA displays variability in vertical descent from the skull base, with greater variability on the left. These findings implore vigilance with evaluation of preoperative imaging and during sinus surgery, especially in the presence of SOEC and CB.

An artificial intelligence algorithm that differentiates anterior ethmoidal artery location on sinus computed tomography scans

2019 ◽  
Vol 134 (1) ◽  
pp. 52-55 ◽  
Author(s):  
J Huang ◽  
A-R Habib ◽  
D Mendis ◽  
J Chong ◽  
M Smith ◽  
...  
Keyword(s):  
Neural Network ◽  
Artificial Intelligence ◽  
Computed Tomography ◽  
Neural Networks ◽  
Convolutional Neural Network ◽  
Convolutional Neural Networks ◽  
Sinus Surgery ◽  
Computed Tomography Scans ◽  
Ethmoidal Artery ◽  
Anterior Ethmoidal Artery

AbstractObjectiveDeep learning using convolutional neural networks represents a form of artificial intelligence where computers recognise patterns and make predictions based upon provided datasets. This study aimed to determine if a convolutional neural network could be trained to differentiate the location of the anterior ethmoidal artery as either adhered to the skull base or within a bone ‘mesentery’ on sinus computed tomography scans.MethodsCoronal sinus computed tomography scans were reviewed by two otolaryngology residents for anterior ethmoidal artery location and used as data for the Google Inception-V3 convolutional neural network base. The classification layer of Inception-V3 was retrained in Python (programming language software) using a transfer learning method to interpret the computed tomography images.ResultsA total of 675 images from 388 patients were used to train the convolutional neural network. A further 197 unique images were used to test the algorithm; this yielded a total accuracy of 82.7 per cent (95 per cent confidence interval = 77.7–87.8), kappa statistic of 0.62 and area under the curve of 0.86.ConclusionConvolutional neural networks demonstrate promise in identifying clinically important structures in functional endoscopic sinus surgery, such as anterior ethmoidal artery location on pre-operative sinus computed tomography.

scholarly journals Endoscopic treatment of a periorbital fat herniation caused by spontaneous solution of continuity of the papyracea lamina

2019 ◽  
Vol 12 (4) ◽  
pp. e229376 ◽  
Author(s):  
Bruno Galletti ◽  
Francesco Gazia ◽  
Cosimo Galletti ◽  
Francesco Galletti
Keyword(s):  
Sinus Surgery ◽  
Computer Assisted ◽  
Assisted Navigation ◽  
Operative Planning ◽  
History Of ◽  
Ethmoidal Artery ◽  
Anterior Ethmoidal Artery ◽  
Fat Herniation ◽  
Visual Disturbances

We present a case of a 16-year-old girl with interruption of papyracea lamina and herniation of the periorbital fat covered by a bone shell. The patient presents with a history of diplopia and visual disturbances ever since she can remember. Thanks to radiological imaging and biopsy, we have done differential diagnosis with periorbital lipoma, intraosseous lipoma and intramuscular lipoma of medial rectus. Diagnostic for images is necessary for a correct operative planning. Endoscopic sinus surgery with computer-assisted navigation is the safest and most effective method to remove the lesion that was closely related to the medial rectum muscle and to the anterior ethmoidal artery. The patient after surgery and in 1 year of follow-up reports the disappearance of symptoms.

scholarly journals The utilization of paranasal sinus coronal tomography scans as a predictor for the anterior ethmoidal artery course.

2020 ◽  
Author(s):  
Hasan Al-Balas ◽  
Amjad Nuseir ◽  
Firas Alzoubi ◽  
Ahmad Alomari ◽  
Bayan Al-Balas ◽  
...  
Keyword(s):  
Ct Scan ◽  
Paranasal Sinus ◽  
Preoperative Evaluation ◽  
University Hospital ◽  
Sinus Surgery ◽  
Face Images ◽  
The Face ◽  
Ethmoidal Artery ◽  
Anterior Ethmoidal Artery ◽  
Ethmoid Labyrinth

Abstract Background. This study aims to identify radiological features on paranasal sinus coronal tomography images that can guide the surgeon to localize and determine the course of the anterior ethmoidal artery (AEA). These features include the visualization of anterior ethmoidal foramen (AEF) and anterior ethmoidal sulcus (AES) as well as the supraorbital pneumatization (SOP). Methods. This retrospective study includes 182 of the paranasal sinuses coronal tomography (CT) for patients who attended the clinic from January 2019 to August 2019 in King Abdullah University Hospital. We excluded the following images from our study: patients younger than twelve years old, patients with a sinus surgery record or trauma, patients with sinus malignancies, congenital anomalies of the face, images with fibro-osseous lesions that impaired the visualization of ethmoid roof, and images with opacified frontal recess region and/or the ethmoidal cells.Results. Both AEF and AES are prominent features on the coronal CT scan that are used to localize the AEA canal and predict its course in the ethmoid labyrinth. It was found that both radiological landmarks are presented in 100% and 93.4 % of our cases; respectively. Moreover, the presence of SOP is significant with the existence of AEA canal on coronal CT scan images.Conclusion. The preoperative evaluation of a coronal CT scan to localize the AEA can be precisely determined by visualization of both the AEF and AES. On the other hand, the presence of SOP is considered a significant sign on the CT scan were AEA can be identified.

scholarly journals Computed tomography assessment of anterior ethmoidal canal dehiscence: An interobserver agreement study and review of the literature

2020 ◽  
Vol 33 (2) ◽  
pp. 145-151 ◽  
Author(s):  
Angela Guarnizo ◽  
Thanh B Nguyen ◽  
Rafael Glikstein ◽  
Nader Zakhari
Keyword(s):  
Computed Tomography ◽  
Interobserver Agreement ◽  
Descriptive Analysis ◽  
Sinus Surgery ◽  
Ct Scans ◽  
Ethmoidal Artery ◽  
Anterior Ethmoidal Artery ◽  
Agreement Study ◽  
Air Cells ◽  
Routine Assessment

Purpose The anterior ethmoidal artery can be injured in functional endoscopic sinus surgery. The ability of computed tomography (CT) to identify dehiscence of the anterior ethmoidal canal (AEC) has not been widely evaluated. The aim of this study was to evaluate the interobserver agreement in the CT assessment of AEC dehiscence. Methods We conducted a retrospective review of consecutive CT scans of the paranasal sinuses (PNS) between January 1, 2012, and December 31, 2012. Two neuroradiologists separately assessed the presence of AEC dehiscence, the presence of PNS opacification, and the best CT plane to evaluate the AEC. Statistical analysis included descriptive analysis and interobserver agreement (kappa coefficient). Results The AEC was below the skull base in 199 (22.3%) cases. Dehiscence of the AEC was found in 13.2% for reader 1 and in 7.3% for reader 2. The interobserver agreement for identification of AEC dehiscence was only fair (κ = 0.246). The interobserver agreement for the AEC dehiscence in cases with opacification of ethmoidal air cells was substantial (κ = 0.754). Conclusion The suboptimal interobserver agreement could potentially limit the usefulness of CT scans for routine assessment of AEC dehiscence. In patients with PNS opacification, CT scans could still add valuable information regarding AEC dehiscence.

A Novel Use of a Landmark to Avoid Injury of the Anterior Ethmoidal Artery during Endoscopic Sinus Surgery

2011 ◽  
Vol 25 (1) ◽  
pp. 54-57 ◽  
Author(s):  
Francisco G. Pernas ◽  
Andrew M. Coughlin ◽  
Sharon E. Hughes ◽  
Roy Riascos ◽  
Patricia A. Maeso
Keyword(s):  
Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Ethmoidal Artery ◽  
Anterior Ethmoidal Artery

International Frontal Sinus Anatomy Classification and Anatomic Predictors of Low-Lying Anterior Ethmoidal Arteries

2017 ◽  
Vol 31 (3) ◽  
pp. 174-176 ◽  
Author(s):  
Phayvanh P. Sjogren ◽  
Rajendra Waghela ◽  
Shaelene Ashby ◽  
Richard H. Wiggins ◽  
Richard R. Orlandi ◽  
...  
Keyword(s):  
Skull Base ◽  
Effect Size ◽  
Frontal Sinus ◽  
Pearson Correlation ◽  
Correlation Coefficients ◽  
Anterior Wall ◽  
Sinus Surgery ◽  
Type I ◽  
Ethmoidal Artery ◽  
Anterior Ethmoidal Artery

Background The International Frontal Sinus Anatomy Classification (IFAC) was introduced to more accurately characterize ethmoid and frontal sinus pneumatization patterns. The prevalence of IFAC cells and their anatomic associations have not been described. Objective The goal was to examine the prevalence of IFAC cells and determine radiologic features associated with a low-lying anterior ethmoidal artery (LAEA). Methods Imaging of adult patients who underwent computed tomographies from January 2015 to March 2016 were retrospectively reviewed by using the IFAC classification. We also measured the distance from the skull base to the anterior ethmoidal artery (AEA), the height of the lateral lamella of the cribriform plate, and anterior-posterior diameter from the anterior wall of the frontal sinus to the skull base (APF). Patients with a history of sinus surgery, trauma, malignancy, or congenital anomaly were excluded. Statistical analysis was performed by using Pearson correlation coefficients and χ2 tests. Results A total of 95 patients met the inclusion criteria. There was a significant association between supraorbital ethmoid cells and an LAEA (p < 0.001), with a significant effect size (ϕ = 0.276, p = 0.007). An inverse relationship was observed between Keros type I classification I and an LAEA (p < 0.001), with a significant effect size (ϕ = -0.414, p = 0.000). Significant associations were found between the AEA distance from the skull base and the cribriform lateral lamella height (R = 0.576, p < 0.001). In addition, there was a significant association between the AEA distance from the skull base and the APF (R = 0.497, p < 0.001). Conclusion The presence of a supraorbital ethmoid cell and a wide APF were associated with an LAEA. There was a significant relationship between Keros type I classification and the AEA adjacent to the skull base. Delineation of these anatomic relationships may be helpful during endoscopic sinus surgery to avoid complications.

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