Department of Ophthalmology, University of Michigan, Ann Arbor, Michigan, USA.
Department of Otolaryngology-Head and Neck Surgery, University of Calfornia, San Diego, California, USA.
Laryngoscope. 2024 Mar;134(3):1096-1099. doi: 10.1002/lary.30963. Epub 2023 Aug 14.
The anterior ethmoidal artery (AEA) is an important structure to identify during endoscopic sinus surgery. Although identification on imaging is easily taught, a consistent endoscopic landmark for the AEA, independent of anatomic ethmoid cell variation, is lacking, leaving many surgeons unclear about the exact location without dependence on navigation. Here, we describe a consistent endoscopic landmark, regardless of anatomical ethmoid variation.
We prospectively enrolled adult patients undergoing endoscopic surgery involving frontal and ethmoid sinuses in this observational study. The AEA landmark was defined simply as the septation or ridge one step back along the ethmoid skull base from the posterior table of the frontal sinus. The gold standard to calculate the sensitivity of our endoscopic landmark was an image-navigation system, registered to within 1.5 mm accuracy, locating the AEA within three planes. Both endoscopic and computerized tomography (CT) images of the pointer at the landmark were taken simultaneously. The concordance of endoscopic to navigation images was independently assessed by three blinded rhinologists.
Forty patients were included in our study with 73 sides analyzed. Diagnoses included chronic rhinosinusitis without polyps (52.5%), with polyps (22.5%), recurrent acute sinusitis (15%), sinonasal tumors (7.5%), and odontogenic sinusitis (2.5%). The AEA was accurately identified using our endoscopic landmark in 97.3% of the cases (71/73). Of the two cases in which the AEA was not found within the landmark, the artery was located ≤1 mm posteriorly.
We describe a consistent endoscopic landmark to identify the AEA, conserved across various clinical diagnoses and anatomic variations in sinus structure.
3 Laryngoscope, 134:1096-1099, 2024.
筛前动脉（AEA）是内镜鼻窦手术中需要识别的重要结构。尽管在影像学上的识别很容易教授，但缺乏一个与解剖性筛窦细胞变异无关的、一致的内镜 AEA 标志，这使得许多外科医生在没有导航的情况下，对确切位置仍感到困惑。在这里，我们描述了一个与解剖变异无关的一致的内镜标志。
我们前瞻性地招募了参与这项观察性研究的需要行内镜手术的额窦和筛窦的成年患者。AEA 标志被简单地定义为筛骨颅底向后退一步，即从前额窦后壁向后退一步的筛骨分隔或嵴。计算我们内镜标志的敏感性的金标准是一个图像导航系统，它以 1.5mm 的精度注册，在三个平面内定位 AEA。同时拍摄标志处指针的内镜和计算机断层扫描（CT）图像。三位盲法鼻科医生独立评估内镜与导航图像的一致性。
我们的研究共纳入 40 例患者，共 73 侧。诊断包括慢性鼻-鼻窦炎不伴息肉（52.5%）、伴息肉（22.5%）、复发性急性鼻窦炎（15%）、鼻-鼻窦肿瘤（7.5%）和牙源性鼻窦炎（2.5%）。在 73 例中，97.3%（71/73）的病例使用我们的内镜标志准确识别了 AEA。在未能在标志内找到 AEA 的两例中，动脉位于标志后≤1mm。
我们描述了一个一致的内镜标志，用于识别 AEA，该标志在各种临床诊断和窦结构的解剖变异中均保持一致。
3 级喉镜，134：1096-1099，2024。
