Related Experiment Video
Updated: Sep 11, 2025
Author Spotlight: Three-Dimensional Cephalometric Landmark Annotation Demonstration on Human Cone Beam Computed Tomography Scans
Published on: September 8, 2023
Nasal Branch of the Anterior Ethmoidal Artery and Cribroethmoidal Groove: New Frontal Sinus Landmarks
Alessandro Vinciguerra1, Mario Turri-Zanoni1, Pierfrancesco Bettini2
1Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, ASST Lariana, Como, Italy.
Objective:
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.
Methods:
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.
Results:
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.
Conclusions:
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 Of Evidence:
Level 4.
Related Concept Videos
01:27Cranial Bones: Lateral View
The temporal bone forms the lower lateral side of the skull. The temporal bone is subdivided into several regions. The flattened upper portion is the squamous portion of the temporal bone. Below this area and projecting anteriorly is the zygomatic process of the temporal bone, which forms the posterior portion of the zygomatic arch. Posteriorly is the mastoid portion of the temporal bone. Projecting...
01:24Nose and Nasal Cavity
01:14Cranial Bones: Superior and Posterior View
The frontal bone is the single bone that forms the forehead. At its anterior midline, between the eyebrows, there is a slight depression called the glabella. The frontal bone also forms the supraorbital margin of the orbit. Near the middle of this margin is the supraorbital foramen, the opening that provides passage for a sensory nerve to the forehead. The frontal bone is thickened just above each supraorbital margin,...
01:29Anatomy of Respiratory System I: Upper Respiratory Tract
Nose and nasal cavity
The nose and nasal cavity represent the main external openings of the respiratory tract....
01:22Sutures of the Skull
Sutures are immobile joints between adjacent bones of the skull. The narrow gap between the bones is filled with dense, fibrous connective tissue that unites the bones. The long sutures located between the skull bones are not straight but instead follow irregular, tightly twisting paths. These twisting lines tightly...
01:08Overview of the Skull
The cranial vault surrounds and protects the brain and houses the middle and inner ear structures. This cavity is bounded superiorly by the rounded top of the skull, which...