Anterior ethmoidal notch

Changed by Henry Knipe, 6 Oct 2019

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The anterior ethmoidal notch contains the anterior ethmoidal artery and has significant rates of anatomic variation that put the artery during function endoscopic sinus surgery (FESS).

Gross anatomy

The anterior ethmoidal notch lies in the medial wall of the superomedial orbit, adjacent to the anterior ethmoid air cells.

Radiographic features

CT

the notch can be identified bilaterally in 95-100% of patients on coronal reformats, and when not seen bilaterally is present unilaterally ¹

Related pathology

During FESS the anterior ethmoidal artery is considered "protected" if the notch is adjacent to the fovea ethmoidalis or lateral lamella. The anterior ethmoidal artery is at increased risk of injury during FESS if there are pneumatised supraorbital anterior ethmoid air cells (occurs in ~30% of patients) ¹.

-<p>The <strong>anterior ethmoidal notch</strong> contains the <a title="Anterior ethmoidal artery" href="/articles/anterior-ethmoidal-artery">anterior ethmoidal artery</a> and has significant rates of anatomic variation that put the artery during <a title="FESS" href="/articles/functional-endoscopic-sinus-surgery-1">function endoscopic sinus surgery (FESS)</a>.</p><h4>Gross anatomy</h4><p>The anterior ethmoidal notch lies in the medial wall of the superomedial <a title="Orbit" href="/articles/orbit">orbit</a>, adjacent to the anterior <a title="Ethmoid air cells" href="/articles/ethmoidal-air-cells">ethmoid air cells</a>. </p><h4>Radiographic features</h4><h5>CT</h5><ul><li>the notch can be identified bilaterally in 95-100% of patients on coronal reformats, and when not seen bilaterally is present unilaterally <sup>1</sup>
-</li></ul><h4>Related pathology</h4><p>During FESS the anterior ethmoidal artery is considered "protected" if the notch is adjacent to the fovea ethmoidalis or lateral lamella. The anterior ethmoidal artery is at increased risk of injury during FESS if there are pneumatised supraorbital anterior ethmoid air cells (occurs in ~30% of patients) <sup>1</sup>.</p><p> </p>
+<p>The <strong>anterior ethmoidal notch</strong> contains the <a href="/articles/anterior-ethmoidal-artery">anterior ethmoidal artery</a> and has significant rates of anatomic variation that put the artery during <a href="/articles/functional-endoscopic-sinus-surgery-1">function endoscopic sinus surgery (FESS)</a>.</p><h4>Gross anatomy</h4><p>The anterior ethmoidal notch lies in the medial wall of the superomedial <a href="/articles/orbit">orbit</a>, adjacent to the anterior <a href="/articles/ethmoidal-air-cells">ethmoid air cells</a>. </p><h4>Radiographic features</h4><h5>CT</h5><ul><li>the notch can be identified bilaterally in 95-100% of patients on coronal reformats, and when not seen bilaterally is present unilaterally <sup>1</sup>
+</li></ul><h4>Related pathology</h4><p>During FESS the anterior ethmoidal artery is considered "protected" if the notch is adjacent to the <a href="/articles/fovea-ethmoidalis">fovea ethmoidalis</a> or <a href="/articles/lateral-lamella">lateral lamella</a>. The anterior ethmoidal artery is at increased risk of injury during FESS if there are pneumatised supraorbital anterior ethmoid air cells (occurs in ~30% of patients) <sup>1</sup>.</p>

References changed:

1. William T. O’Brien, Sr, Stefan Hamelin, Erik K. Weitzel. The Preoperative Sinus CT: Avoiding a “CLOSE” Call with Surgical Complications. (2016) Radiology. 281 (1): 10-21. <a href="https://doi.org/10.1148/radiol.2016152230">doi:10.1148/radiol.2016152230</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/27643765">Pubmed</a> <span class="ref_v4"></span>
2. Ding J, Sun G, Lu Y, Yu BB, Li M, Li L, Li GY, Peng ZH, Zhang XP. Evaluation of anterior ethmoidal artery by 320-slice CT angiography with comparison to three-dimensional spin digital subtraction angiography: initial experiences. (2012) Korean journal of radiology. 13 (6): 667-73. <a href="https://doi.org/10.3348/kjr.2012.13.6.667">doi:10.3348/kjr.2012.13.6.667</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/23118564">Pubmed</a> <span class="ref_v4"></span>

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