Erwin Dylan Z, Liu Matthew Y, Krysinski Mason R, Choi Alexander M, Tantiwongkosi Bundhit, Chen Philip G
Department of Otolaryngology & Head and Neck Surgery, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
Department of Otolaryngology & Head and Neck Surgery, Vanderbilt University, Nashville, TN, USA.
Ann Otol Rhinol Laryngol. 2025 Feb;134(2):65-69. doi: 10.1177/00034894241293390. Epub 2024 Oct 29.
Allergic fungal rhinosinusitis (AFRS) often results in expansion of disease beyond the paranasal sinuses, which may put important structures, such as the anterior ethmoid artery (AEA) or lateral lamella of the cribiform, at risk of injury during endoscopic sinus surgery (ESS). This study aims to compare the AEA to skull base (AEA-SB) length in patients with AFRS versus chronic rhinosinusitis with nasal polyps (CRSwNP), as well as additional anatomic variants.
A single institutional retrospective chart review of patients undergoing ESS for AFRS and CRSwNP was performed. AEA-SB length were compared between the 2 groups. Other anatomic variants, including Keros measurement and presence of supraorbital ethmoid air cells (SOEC), concha bullosa (CB), sphenoethmoidal, and infraorbital ethmoid cells were measured and compared between the 2 groups.
Twenty-one patients were included in each cohort. The AFRS group was younger in age ( = .015) and had a significantly longer AEA-SB length ( = .014) compared to the CRSwNP group. No significant differences were observed between the 2 groups regarding Keros measurement, presence of concha bullosa, infraorbital ethmoid, sphenoethmoidal, or SOEC. No association was seen between AEA-SB length and Keros class in either group.
AFRS harbors anatomical differences when compared to CRSwNP, with the former associated with a longer AEA-SB length. This key difference should be considered in preoperative planning to prevent injury to the AEA in patients undergoing ESS for AFRS.
变应性真菌性鼻-鼻窦炎（AFRS）常导致鼻窦外的病变扩展，这可能使筛前动脉（AEA）或筛板外侧骨板等重要结构在内镜鼻窦手术（ESS）期间有受伤风险。本研究旨在比较AFRS患者与慢性鼻-鼻窦炎伴鼻息肉（CRSwNP）患者的AEA至颅底（AEA-SB）长度，以及其他解剖变异情况。
对接受ESS治疗的AFRS和CRSwNP患者进行单机构回顾性病历审查。比较两组之间的AEA-SB长度。测量并比较两组之间的其他解剖变异，包括Keros测量以及眶上筛气房（SOEC）、泡状鼻甲（CB）、蝶筛气房和眶下筛气房的存在情况。
每个队列纳入21例患者。与CRSwNP组相比，AFRS组年龄更小（P = 0.015），且AEA-SB长度显著更长（P = 0.014）。两组在Keros测量、泡状鼻甲、眶下筛气房、蝶筛气房或SOEC的存在情况方面未观察到显著差异。两组中AEA-SB长度与Keros分级之间均未发现关联。
与CRSwNP相比，AFRS存在解剖学差异，前者与更长的AEA-SB长度相关。在为AFRS患者进行ESS的术前规划中应考虑这一关键差异，以防止损伤AEA。
