Vinciguerra Alessandro, Turri-Zanoni Mario, Bettini Pierfrancesco, Arosio Alberto Daniele, Gandolfi Alberto, Balzi Daniel, Schiavo Gloria, Russo Federico, Valentini Marco, Ferrari Marco, Castelnuovo Paolo, Herman Philippe, Bignami Maurizio, Battaglia Paolo
Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, ASST Lariana, Como, Italy.
ENT and Audiology Department, University of Ferrara, Ferrara, Italy.
Laryngoscope. 2025 Aug 13. doi: 10.1002/lary.70041.
Expanded frontal sinusotomies (Draf IIb/c-III) are essential surgical procedures for managing complex frontal sinus pathologies. However, traditional anatomical landmarks may be difficult to identify, particularly in tumor or revision cases. This manuscript investigates the nasal branch of the anterior ethmoidal artery (NbAEA) and the cribroethmoidal groove (CrEGr) as reliable and consistent landmarks for endoscopic frontal sinusotomies.
This study included anatomical dissections (medio-lateral approach) on three fresh cadavers (six sides) focused on the region anterior to the first olfactory phylum, namely the cribo-frontal area. Additionally, a retrospective clinical case series of patients that underwent centripetal dissection with a medio-lateral approach to the frontal sinus was performed. Identification of NbAEA, CrEGr, and the first olfactory phylum, along with surgical outcomes and complications, was analyzed.
The NbAEA and CrEGr were identified in all dissected sides and were located anterior to the first olfactory phylum. Considering the 19 enrolled patients, 13/19 (68.4%) were treated with a bilateral centripetal dissection and Draf III procedure (26 sides); whereas 6/19 patients (31.6%) underwent a unilateral approach with a Draf IIb/c procedure. The NbAEA and CrEGr were identified in all cases (100%) and in only 9/19 cases (47.7%) the first olfactory phylum was additionally exposed, reinforcing the role of these new anatomical landmarks. No perioperative complications were recorded.
This study supports the clinical significance of NbAEA and CrEGr as reliable anatomical landmarks, and their identification in 100% of cases reinforces their practical applicability in surgical approaches to the frontal sinus.
Level 4.
扩大额窦切开术（Draf IIb/c-III型）是处理复杂额窦病变的重要外科手术。然而，传统的解剖标志可能难以辨认，尤其是在肿瘤或翻修病例中。本文探讨筛前动脉鼻支（NbAEA）和筛筛窦沟（CrEGr）作为内镜额窦切开术可靠且一致的标志。
本研究包括对三具新鲜尸体（六个侧面）进行的解剖（中外侧入路），重点关注第一嗅门前方的区域，即筛额区域。此外，对采用中外侧入路向额窦进行向心性解剖的患者进行了回顾性临床病例系列研究。分析了NbAEA、CrEGr和第一嗅门的识别情况，以及手术结果和并发症。
在所有解剖侧面均识别出NbAEA和CrEGr，且它们位于第一嗅门前方。纳入的19例患者中，13/19（68.4%）接受了双侧向心性解剖和Draf III型手术（26个侧面）；而6/19例患者（31.6%）采用单侧入路行Draf IIb/c型手术。所有病例（100%）均识别出NbAEA和CrEGr，仅9/19例（47.7%）额外暴露了第一嗅门，这进一步强化了这些新解剖标志的作用。未记录围手术期并发症。
本研究支持NbAEA和CrEGr作为可靠解剖标志的临床意义，且在100%的病例中识别出它们强化了其在额窦手术入路中的实际应用价值。
4级。
