Supraorbital Ethmoid Air Cell - Its Role in Sinonasal Pathologies

Area of Science:

• Otolaryngology
• Neurosurgery
• Radiology

Background:

• The supraorbital ethmoid air cell (SOEC) is an anatomical variation within the ethmoid air cell system.
• SOEC pneumatizes the orbital plate of the frontal bone and impacts frontal recess anatomy.

Purpose of the Study:

• To investigate the incidence, characteristics, and associated pathologies of SOEC.
• To highlight the clinical significance of SOEC in sinonasal surgery and its impact on recurrence rates.

Main Methods:

• A cross-sectional observational study of 100 patients with SOEC undergoing CT PNS for sinonasal pathologies.
• Analysis of CT scans to identify SOEC type, extent, and associated anatomical variations like low-lying cribriform plate and anterior ethmoid artery (AEA) position.

Main Results:

• SOEC incidence was 43%, with the medial orbital wall extension being most common (37%).
• Low-lying Keros type 3 cribriform plate (49%) and free-hanging AEA (83%) were frequent associations.
• Chronic rhinosinusitis and mucoceles were the most common pathologies; sinusitis recurrence was high due to misidentification of SOEC.

Conclusions:

• SOEC is a significant anatomical variation requiring careful preoperative assessment via CT.
• Preoperative identification of SOEC and associated structures prevents surgical complications and reduces sinusitis recurrence.
• Understanding SOEC's orientation is vital for surgical planning and achieving optimal outcomes in sinonasal procedures.