The patient was noted to have tumor superior to the anterior ethmoid artery
and pedicled off the lamina papyracea.
Second, the anterior ethmoid artery
is vulnerable to injury which can cause devastating bleeding into the orbit.
Twelve areas were specifically looked at for anatomical variations (Table 1) including; Type of skull base, Anterior ethmoid artery
, Agger nasi cells, Haller cells, asymmetry in anterior ethmoidal and onodi cells.
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 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, a branch of the ophthalmic artery, leaves the orbit via the anterior ethmoid foramen, crosses the roof of the anterior ethmoid sinus, and supplies the anterior ethmoid cells and frontal sinus (figure, A).
It is normally much smaller than the anterior ethmoid artery. (1-4) The posterior ethmoid artery supplies the posterosuperior portion of the lateral nasal wall (superior turbinate) and a corresponding portion of the nasal septum.
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.
A branch of the anterior ethmoid artery
was observed along the posterior wall of this cavity (figure, D).