We also discuss an important point that has not been adequately addressed in the literature to date--that is, the fact that the use of the frontoethmoid suture line and the anterior ethmoid artery as a guide to the skull base can be inaccurate.
Insufficient attention has been paid to the fact that the frontoethmoid suture line and the anterior ethmoid artery are not always an accurate guide to the skull base during transnasal canthopexy; at most, this problem has been mentioned only in passing in many literature reports and well-known textbooks.
CT also showed that the foramen of the anterior ethmoid artery traversed the superior nasal cavity in its own mesentery, as seen in the patient's right superior nasal cavity (figure 1, B).
We attempted to trace the frontoethmoid suture line and the anterior ethmoid artery in the involved orbit, while also correlating with the other side, in order to be sure that the direction of our drilling was inferior to the anterior skull base and the cribriform plate, given our knowledge that these are anecdotally reliable markers.
The literature on the use of the frontoethmoid suture line and the anterior ethmoid artery as markers for the skull base is limited.
Our case serves to point out that the relationship of (1) the level of the frontoethmoid suture line and the anterior ethmoid artery to (2) the cribriform plate and the intracranial cavity is variable.
The various steps include anterior and posterior nasal packing, direct cauterization, external carotid artery ligation, selective maxillary artery embolization, transantral maxillary artery ligation, anterior ethmoid artery
ligation, and septoplasty.
The anterior ethmoid artery supplies the anterior one-third of the lateral wall of the nasal cavity and a similar portion of the nasal septum.
It is normally much smaller than the anterior ethmoid artery.
According to Stammberger, one way to find the anterior ethmoid artery by the endoscopic approach is to follow the anterior surface of the ethmoid bulla in the direction of the roof of the ethmoid sinus.
If recurrent or persistent severe posterior epistaxis should occur following internal maxillary and anterior ethmoid artery ligation, Lander and Terry suggest that the source of the bleeding might be the posterior ethmoid artery.