TY - JOUR
T1 - Intraconal Anatomy of the Anterior Ethmoidal Neurovascular Bundle
T2 - Implications for Surgery in the Superomedial Orbit
AU - Li, Lifeng
AU - London, Nyall R.
AU - Prevedello, Daniel M.
AU - Carrau, Ricardo L.
N1 - Publisher Copyright:
© The Author(s) 2020.
PY - 2020/5/1
Y1 - 2020/5/1
N2 - Background: The anterior ethmoidal artery (AEA) branches from the ophthalmic artery in the superomedial intraconal space. The feasibility of management of lesions arising from the superomedial intraconal space via an endoscopic endonasal approach has not been sufficiently explored. Objective: To yield a detailed anatomic description of the anterior ethmoidal neurovascular bundle and its variants to serve as the foundation for possible management of lesions in the superomedial intraconal space. Methods: Eight cadaveric specimens (16 sides) were dissected using an endonasal approach, tracing the AEA proximally through the superomedial intraconal space. Furthermore, the anatomy of adjacent structures was noted, and distances from the anterior ethmoidal foramen to the origin of the AEA at the ophthalmic artery were measured. Results: Supraorbital cells were found in 13/16 sides (81.25%), and a bony dehiscence of the anterior ethmoidal canal was observed in 5/16 sides (31.25%). The nasociliary nerve, ophthalmic artery, superior division of the oculomotor nerve, superior rectus muscle, and levator palpebrae superioris were routinely identified in the superomedial intraconal space. The AEA passed through a corridor between the medial rectus and superior oblique muscles after arising from the ophthalmic artery (lateral to the foramen) in all specimens. The average distance from its origin to the anterior ethmoidal foramen was 5.19 ± 0.98 mm. Conclusion: Anatomically, it is feasible to access the superomedial intraconal space via an endoscopic endonasal approach. This study provides the anatomical basis for procedures in the superomedial intraconal space.
AB - Background: The anterior ethmoidal artery (AEA) branches from the ophthalmic artery in the superomedial intraconal space. The feasibility of management of lesions arising from the superomedial intraconal space via an endoscopic endonasal approach has not been sufficiently explored. Objective: To yield a detailed anatomic description of the anterior ethmoidal neurovascular bundle and its variants to serve as the foundation for possible management of lesions in the superomedial intraconal space. Methods: Eight cadaveric specimens (16 sides) were dissected using an endonasal approach, tracing the AEA proximally through the superomedial intraconal space. Furthermore, the anatomy of adjacent structures was noted, and distances from the anterior ethmoidal foramen to the origin of the AEA at the ophthalmic artery were measured. Results: Supraorbital cells were found in 13/16 sides (81.25%), and a bony dehiscence of the anterior ethmoidal canal was observed in 5/16 sides (31.25%). The nasociliary nerve, ophthalmic artery, superior division of the oculomotor nerve, superior rectus muscle, and levator palpebrae superioris were routinely identified in the superomedial intraconal space. The AEA passed through a corridor between the medial rectus and superior oblique muscles after arising from the ophthalmic artery (lateral to the foramen) in all specimens. The average distance from its origin to the anterior ethmoidal foramen was 5.19 ± 0.98 mm. Conclusion: Anatomically, it is feasible to access the superomedial intraconal space via an endoscopic endonasal approach. This study provides the anatomical basis for procedures in the superomedial intraconal space.
KW - anterior ethmoidal artery
KW - intraconal space
KW - medial rectus muscle
KW - superior oblique muscle
KW - supraorbital cell
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U2 - 10.1177/1945892420901630
DO - 10.1177/1945892420901630
M3 - Article
C2 - 31973546
AN - SCOPUS:85078091393
SN - 1945-8924
VL - 34
SP - 394
EP - 400
JO - American Journal of Rhinology and Allergy
JF - American Journal of Rhinology and Allergy
IS - 3
ER -